中国临床药理学与治疗学 ›› 2026, Vol. 31 ›› Issue (4): 474-485.doi: 10.12092/j.issn.1009-2501.2026.04.006
张佳娴1,2(
), 肖坚2, 黄行行2,3, 李梦瑶1,2, 鱼婷1,2, 于慧敏2, 李靖阳2, 宁磊2, 王莹1,*()
收稿日期:2025-04-18
修回日期:2025-05-12
出版日期:2026-04-26
发布日期:2026-04-30
通讯作者:
王莹
E-mail:zhangjiaxian2023@163.com;wangying811128@163.com
作者简介:张佳娴，女，硕士，研究方向：临床药学。E-mail：基金资助:
Jiaxian ZHANG1,2(), Jian XIAO2, Hangxing HUANG2,3, Mengyao LI1,2, Ting YU1,2, Huimin YU2, Jingyang LI2, Lei NING2, Ying WANG1,*()
Received:2025-04-18
Revised:2025-05-12
Online:2026-04-26
Published:2026-04-30
Contact:
Ying WANG
E-mail:zhangjiaxian2023@163.com;wangying811128@163.com
摘要：
目的: 慢性阻塞性肺疾病（COPD）是一种全球流行的疾病，在中国也有大量患者。目前尚缺乏关于中国慢性阻塞性肺疾病门诊患者药物相关问题（drug related problems，DRPs）的数据。本文旨在研究中南大学湘雅医院慢性阻塞性肺疾病门诊患者中DRPs类型、原因、发生的相关因素和潜在诱因。方法: 经伦理委员会的批准，在2020年9月至2021年11月期间，461名慢性阻塞性肺疾病患者被纳入这项回顾性研究，他们至少使用了一种药物。DRPs采用欧洲药品护理网络（PCNE）DRP分类系统（PCNE V9.10）进行审查分类。除描述性统计外，还采用了单因素和Logistic回归来探索DRPs的潜在危险因素。结果: 461名患者共识别了239个DRPs，567个相应的原因。“治疗有效性：治疗效果不佳”是最常见的问题类型（91.2%；218/239）。最可能的原因是“没有进行或没有适当的疗效监测”（31.0%；176/567）和“患者相关”（27.5%；156/567）。年龄、吸烟（主动）、合并支气管扩张和矽肺、使用喹诺酮类和林可霉素类抗生素、LABA+LAMA组合的吸入制剂、有急性加重病史的患者更有可能出现药物相关问题。结论: DRPs在中国慢性阻塞性肺疾病门诊患者中很常见，主要与治疗效果不佳密切相关。未来，临床药师在解决这些问题及实施干预方面可起到重要作用。
中图分类号:
张佳娴, 肖坚, 黄行行, 李梦瑶, 鱼婷, 于慧敏, 李靖阳, 宁磊, 王莹. 慢性阻塞性肺疾病门诊患者的药物相关问题及其相关因素：一项横断面回顾性研究[J]. 中国临床药理学与治疗学, 2026, 31(4): 474-485.
Jiaxian ZHANG, Jian XIAO, Hangxing HUANG, Mengyao LI, Ting YU, Huimin YU, Jingyang LI, Lei NING, Ying WANG. Drug-related problems and its associated factors among outpatients with COPD: A cross sectional retrospective study[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(4): 474-485.
图 1
Fig.1 Flowchart for identifying drug-related problems in research
| Characteristics | n(%) |
| Age(year), Mean (SD) | 64.03(9.33) |
| Gender | |
| Male | 386(83.73) |
| Female | 75(16.27) |
| Risk factors | |
| Dust | 35(7.59) |
| Lampblack | 40(8.68) |
| Smoking passive | |
| Yes | 17(3.69) |
| No | 444(96.31) |
| Smoking active | |
| Yes | 349(75.70) |
| No | 112(24.30) |
| Cessation(year), Mean (SD) | 5.26(7.73) |
| Smoking(year), Mean (SD) | 31.29(12.91) |
| Length of exacerbations in the previous year (time), Mean (SD) | 1.17(1.29) |
| Length of hospital stay in the previous year (time), Mean (SD) | 0.48(0.88) |
| Comorbidities | |
| Hypertension | 14(3.04) |
| Diabetes mellitus | 6(1.30) |
| Coronary artery disease | 23(4.99) |
| Bronchiectasis | 62(13.44) |
| Lung cancer | 9(1.95) |
| Asthma | 48(10.41) |
| Bronchitis | 47(10.20) |
| Pulmonary infection | 90(19.52) |
| Pulmonary nodule | 91(19.74) |
| Silicosis | 7(1.52) |
| Inhalation therapies | |
| LABA | 18(3.90) |
| LAMA | 25(5.42) |
| LABA/LAMA | 106(23.00) |
| LABA/ICS | 69(14.97) |
| LAMA/ICS | 2(0.43) |
| LABA/LAMA/ICS | 46(9.98) |
| Antibiotics | |
| Fluoroquinolones | 121(26.25) |
| Macrolides | 4(0.87) |
| Lincosamides | 6(1.30) |
| Cephalosporins | 24(5.21) |
表 1
Table 1 Characterization of the study population (n=461)
| Characteristics | n(%) |
| Age(year), Mean (SD) | 64.03(9.33) |
| Gender | |
| Male | 386(83.73) |
| Female | 75(16.27) |
| Risk factors | |
| Dust | 35(7.59) |
| Lampblack | 40(8.68) |
| Smoking passive | |
| Yes | 17(3.69) |
| No | 444(96.31) |
| Smoking active | |
| Yes | 349(75.70) |
| No | 112(24.30) |
| Cessation(year), Mean (SD) | 5.26(7.73) |
| Smoking(year), Mean (SD) | 31.29(12.91) |
| Length of exacerbations in the previous year (time), Mean (SD) | 1.17(1.29) |
| Length of hospital stay in the previous year (time), Mean (SD) | 0.48(0.88) |
| Comorbidities | |
| Hypertension | 14(3.04) |
| Diabetes mellitus | 6(1.30) |
| Coronary artery disease | 23(4.99) |
| Bronchiectasis | 62(13.44) |
| Lung cancer | 9(1.95) |
| Asthma | 48(10.41) |
| Bronchitis | 47(10.20) |
| Pulmonary infection | 90(19.52) |
| Pulmonary nodule | 91(19.74) |
| Silicosis | 7(1.52) |
| Inhalation therapies | |
| LABA | 18(3.90) |
| LAMA | 25(5.42) |
| LABA/LAMA | 106(23.00) |
| LABA/ICS | 69(14.97) |
| LAMA/ICS | 2(0.43) |
| LABA/LAMA/ICS | 46(9.98) |
| Antibiotics | |
| Fluoroquinolones | 121(26.25) |
| Macrolides | 4(0.87) |
| Lincosamides | 6(1.30) |
| Cephalosporins | 24(5.21) |
| Assessments | n(%) |
| mMRC Breathlessness Scale | |
| 0 Not troubled by breathlessness except on strenuous exercise | 6(1.30) |
| 1 Short of breath when hurrying or walking up a slight hill | 217(47.07) |
| 2 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace | 159(34.49) |
| 3 Stops for breath after walking about 100 meters or after a few minutes on level ground | 53(11.50) |
| 4 Too breathless to leave the house, or breathless when dressing or undressing | 26(5.64) |
| CAT, Mean (SD) | |
| Cough | 1.87(1.02) |
| Phlegm | 1.69(0.96) |
| Chest tightness | 1.87(1.10) |
| Breathlessness | 2.20(1.29) |
| Activities | 1.87(1.25) |
| Confidence | 1.84(1.27) |
| Sleep | 1.71(1.08) |
| Energy | 1.67(1.08) |
| CAT score | 14.72(6.99) |
| CCQ, Mean (SD) | |
| Short of breath while at rest | 1.66(1.16) |
| Short of breath while doing physical activities | 3.00(1.61) |
| Concerned about getting a cold or your breathing getting worse | 2.00(1.37) |
| Depressed (down) because of your breathing problems | 1.92(1.33) |
| Cough | 2.50(1.22) |
| Sputum or phlegm (chest mucus) | 2.33(1.16) |
| Strenuous physical activities | 3.15(1.62) |
| Moderate physical activities | 2.43(1.41) |
| Daily activities at home | 2.07(1.41) |
| Social activities | 1.72(1.27) |
| CCQ Points | 2.57(1.27) |
| CCQ- Symptoms | 2.37(0.92) |
| CCQ- Functional state | 2.34(1.28) |
| CCQ- Mental state | 1.96(1.32) |
| EQ-5D | |
| Mobility | |
| I have no problems in walking about | 358(77.66) |
| I have some problems in walking about | 79(17.14) |
| I am confined to bed | 24(5.20) |
| Self-care | |
| I have no problems with self-care | 366(79.39) |
| I have some problems washing or dressing myself | 79(17.14) |
| I am unable to wash or dress myself | 16(3.47) |
| Usual activity (e.g. work, study, housework, family or leisure activities) | |
| I have no problems with perfor ming my usual activities | 354(76.79) |
| I have some problems with performing my usual activities | 89(19.31) |
| I am unable to perform my usual activities | 18(3.90) |
| Pain/discomfort | |
| I have no pain or discomfort | 324(70.28) |
| I have moderate pain or discomfort | 115(24.95) |
| I have extreme pain or discomfort | 22(4.77) |
| Anxiety/depression | |
| I am not anxious or depressed | 355(77.01) |
| I am moderately anxious or depressed | 91(19.74) |
| I am extremely anxious or depressed | 15(3.25) |
| Self-rated health index, Mean (SD) | 67.24(16.73) |
| MMAM-4 | |
| High (=4) | 102(22.13) |
| Medium (2-3) | 329(71.36) |
| Low (0-1) | 30(6.51) |
表 2
Table 2 Clinical efficacy characteristics of participants (n=461)
| Assessments | n(%) |
| mMRC Breathlessness Scale | |
| 0 Not troubled by breathlessness except on strenuous exercise | 6(1.30) |
| 1 Short of breath when hurrying or walking up a slight hill | 217(47.07) |
| 2 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace | 159(34.49) |
| 3 Stops for breath after walking about 100 meters or after a few minutes on level ground | 53(11.50) |
| 4 Too breathless to leave the house, or breathless when dressing or undressing | 26(5.64) |
| CAT, Mean (SD) | |
| Cough | 1.87(1.02) |
| Phlegm | 1.69(0.96) |
| Chest tightness | 1.87(1.10) |
| Breathlessness | 2.20(1.29) |
| Activities | 1.87(1.25) |
| Confidence | 1.84(1.27) |
| Sleep | 1.71(1.08) |
| Energy | 1.67(1.08) |
| CAT score | 14.72(6.99) |
| CCQ, Mean (SD) | |
| Short of breath while at rest | 1.66(1.16) |
| Short of breath while doing physical activities | 3.00(1.61) |
| Concerned about getting a cold or your breathing getting worse | 2.00(1.37) |
| Depressed (down) because of your breathing problems | 1.92(1.33) |
| Cough | 2.50(1.22) |
| Sputum or phlegm (chest mucus) | 2.33(1.16) |
| Strenuous physical activities | 3.15(1.62) |
| Moderate physical activities | 2.43(1.41) |
| Daily activities at home | 2.07(1.41) |
| Social activities | 1.72(1.27) |
| CCQ Points | 2.57(1.27) |
| CCQ- Symptoms | 2.37(0.92) |
| CCQ- Functional state | 2.34(1.28) |
| CCQ- Mental state | 1.96(1.32) |
| EQ-5D | |
| Mobility | |
| I have no problems in walking about | 358(77.66) |
| I have some problems in walking about | 79(17.14) |
| I am confined to bed | 24(5.20) |
| Self-care | |
| I have no problems with self-care | 366(79.39) |
| I have some problems washing or dressing myself | 79(17.14) |
| I am unable to wash or dress myself | 16(3.47) |
| Usual activity (e.g. work, study, housework, family or leisure activities) | |
| I have no problems with perfor ming my usual activities | 354(76.79) |
| I have some problems with performing my usual activities | 89(19.31) |
| I am unable to perform my usual activities | 18(3.90) |
| Pain/discomfort | |
| I have no pain or discomfort | 324(70.28) |
| I have moderate pain or discomfort | 115(24.95) |
| I have extreme pain or discomfort | 22(4.77) |
| Anxiety/depression | |
| I am not anxious or depressed | 355(77.01) |
| I am moderately anxious or depressed | 91(19.74) |
| I am extremely anxious or depressed | 15(3.25) |
| Self-rated health index, Mean (SD) | 67.24(16.73) |
| MMAM-4 | |
| High (=4) | 102(22.13) |
| Medium (2-3) | 329(71.36) |
| Low (0-1) | 30(6.51) |
图 2
Fig.2 Classification of DRPS determined using the Pharmaceutical Care Network Europe (PCNE) V9.10
| Problems domain | n(%) | |
| Total | 567 | |
| C 1 | Drug selection | 40(7.05) |
| C 1.1 | Inappropriate drug according to guidelines/formulary | 21(52.50) |
| C 1.5 | No or incomplete drug treatment in spite of existing indication | 18(45.00) |
| C 1.6 | Too many different drugs/active ingredients prescribed for indication | 1(2.50) |
| C 4 | Treatment duration | 83(14.64) |
| C 4.1 | Duration of treatment too short | 83(100.00) |
| C 6 | Drug use process | 112(19.75) |
| C 6.1 | Inappropriate timing of administration and/or dosing intervals | 29(25.89) |
| C 6.2 | Drug under-administered by a health professional | 29(25.89) |
| C 6.4 | Drug not administered at all by a health professional | 54(48.21) |
| C 7 | Patient related | 156(27.51) |
| C 7.1 | Patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason | 66(42.31) |
| C 7.2 | Patient uses/takes more drug than prescribed | 7(4.49) |
| C 7.3 | Patient abuses drug (unregulated overuse) | 7(4.49) |
| C 7.5 | Patient takes food that interacts | 34(21.79) |
| C 7.7 | Inappropriate timing or dosing intervals | 33(21.15) |
| C 7.8 | Patient unintentionally administers/uses the drug in a wrong way | 1(0.64) |
| C 7.10 | Patient unable to understand instructions properly | 8(5.13) |
| C 9 | Other | 176(31.04) |
| C 9.1 | No or inappropriate outcome monitoring (incl. TDM) | 157(89.20) |
| C 9.3 | No obvious cause | 19(10.80) |
表 3
Table 3 Causes of DRPs according to PCNE V9.10 classification (n=567)
| Problems domain | n(%) | |
| Total | 567 | |
| C 1 | Drug selection | 40(7.05) |
| C 1.1 | Inappropriate drug according to guidelines/formulary | 21(52.50) |
| C 1.5 | No or incomplete drug treatment in spite of existing indication | 18(45.00) |
| C 1.6 | Too many different drugs/active ingredients prescribed for indication | 1(2.50) |
| C 4 | Treatment duration | 83(14.64) |
| C 4.1 | Duration of treatment too short | 83(100.00) |
| C 6 | Drug use process | 112(19.75) |
| C 6.1 | Inappropriate timing of administration and/or dosing intervals | 29(25.89) |
| C 6.2 | Drug under-administered by a health professional | 29(25.89) |
| C 6.4 | Drug not administered at all by a health professional | 54(48.21) |
| C 7 | Patient related | 156(27.51) |
| C 7.1 | Patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason | 66(42.31) |
| C 7.2 | Patient uses/takes more drug than prescribed | 7(4.49) |
| C 7.3 | Patient abuses drug (unregulated overuse) | 7(4.49) |
| C 7.5 | Patient takes food that interacts | 34(21.79) |
| C 7.7 | Inappropriate timing or dosing intervals | 33(21.15) |
| C 7.8 | Patient unintentionally administers/uses the drug in a wrong way | 1(0.64) |
| C 7.10 | Patient unable to understand instructions properly | 8(5.13) |
| C 9 | Other | 176(31.04) |
| C 9.1 | No or inappropriate outcome monitoring (incl. TDM) | 157(89.20) |
| C 9.3 | No obvious cause | 19(10.80) |
| Determinates | Patients with DRPs (n=239) | Patients without DRPs (n=222) | Univariate analysis | Multivariate analysis | |||
| P value | OR (95%CI) | P value | VIF | ||||
| Age(year), Mean (SD) | 66.10(9.24) | 61.80(8.93) | <0.01** | 1.033(1.004,1.062) | 0.023* | 1.02 | |
| Gender, n(%) | |||||||
| Male | 205(85.77) | 181(81.53) | 0.256 | ||||
| Female | 34(14.23) | 41(18.47) | |||||
| Risk factors | |||||||
| Dust, n(%) | 14(5.86) | 21(9.46) | 0.162 | ||||
| Lampblack, n(%) | 18(7.53) | 22(9.91) | 0.410 | ||||
| Smoking passive, n(%) | |||||||
| Yes | 9(3.77) | 8(3.60) | 1.000 | ||||
| No | 230(96.23) | 214(96.40) | |||||
| Smoking active, n(%) | |||||||
| Yes | 193(80.75) | 156(70.27) | <0.01** | 0.347(0.182,0.663) | <0.01** | 1.08 | |
| No | 46(19.25) | 66(29.73) | |||||
| Cessation(year), Mean (SD) | 5.31(6.65) | 5.21(8.77) | <0.01** | ||||
| Smoking(year), Mean (SD) | 33.19(11.73) | 28.88(13.95) | 0.014* | ||||
| Length of exacerbations in the previous year (times), Mean (SD) | 1.41(1.46) | 0.90(1.01) | <0.01** | 1.324(1.037,1.690) | 0.024* | 1.03 | |
| Length of hospital stay in the previous year (times), Mean (SD) | 0.71(1.05) | 0.24(0.55) | <0.01** | ||||
| Comorbidities, n(%) | |||||||
| Hypertension | 7(2.93) | 7(3.15) | 1.000 | ||||
| Diabetes mellitus | 1(0.41) | 5(2.25) | 0.110 | ||||
| Coronary artery disease | 10(4.18) | 15(6.76) | 0.522 | ||||
| Bronchiectasis | 38(15.90) | 24(10.81) | 0.133 | 0.352(0.166,0.746) | <0.01** | 1.11 | |
| Lung cancer | 6(2.51) | 3(1.35) | 0.506 | ||||
| Asthma | 19(7.95) | 29(13.06) | 0.093 | ||||
| Bronchitis | 28(11.72) | 19(8.56) | 0.284 | ||||
| Pulmonary infection | 52(21.76) | 38(17.12) | 0.240 | ||||
| Pulmonary nodule | 47(19.67) | 44(19.82) | 1.000 | ||||
| Silicosis | 6(2.51) | 1(0.45) | 0.124 | 0.056(0.005,0.662) | 0.022* | 1.02 | |
| Inhalation therapies, n(%) | |||||||
| LABA | 9(3.77) | 9(4.05) | 1.000 | ||||
| LAMA | 9(3.77) | 16(7.21) | 0.148 | ||||
| LABA/LAMA | 68(28.45) | 38(17.12) | <0.01** | 0.359(0.191,0.674) | <0.01** | 1.02 | |
| LABA/ICS | 36(15.06) | 33(14.86) | 1.000 | ||||
| LAMA/ICS | 2(0.84) | - | 0.500 | ||||
| LABA/LAMA/ICS | 27(11.30) | 19(8.56) | 0.354 | ||||
| Antibiotics, n(%) | |||||||
| Fluoroquinolones | 63(26.40) | 58(26.13) | 0.290 | 3.555(1.206,10.480) | 0.021* | 1.05 | |
| Macrolides | 2(0.84) | 2(0.90) | 1.000 | ||||
| Lincosamides | 1(0.42) | 5(2.25) | 0.110 | 12.292(1.037,145.668) | 0.047* | 1.02 | |
| Cephalosporins | 19(7.95) | 5(2.25) | <0.01** | ||||
表 4
Table 4 Risk factors associated with the occurrence of DRPs in outpatients with COPD
| Determinates | Patients with DRPs (n=239) | Patients without DRPs (n=222) | Univariate analysis | Multivariate analysis | |||
| P value | OR (95%CI) | P value | VIF | ||||
| Age(year), Mean (SD) | 66.10(9.24) | 61.80(8.93) | <0.01** | 1.033(1.004,1.062) | 0.023* | 1.02 | |
| Gender, n(%) | |||||||
| Male | 205(85.77) | 181(81.53) | 0.256 | ||||
| Female | 34(14.23) | 41(18.47) | |||||
| Risk factors | |||||||
| Dust, n(%) | 14(5.86) | 21(9.46) | 0.162 | ||||
| Lampblack, n(%) | 18(7.53) | 22(9.91) | 0.410 | ||||
| Smoking passive, n(%) | |||||||
| Yes | 9(3.77) | 8(3.60) | 1.000 | ||||
| No | 230(96.23) | 214(96.40) | |||||
| Smoking active, n(%) | |||||||
| Yes | 193(80.75) | 156(70.27) | <0.01** | 0.347(0.182,0.663) | <0.01** | 1.08 | |
| No | 46(19.25) | 66(29.73) | |||||
| Cessation(year), Mean (SD) | 5.31(6.65) | 5.21(8.77) | <0.01** | ||||
| Smoking(year), Mean (SD) | 33.19(11.73) | 28.88(13.95) | 0.014* | ||||
| Length of exacerbations in the previous year (times), Mean (SD) | 1.41(1.46) | 0.90(1.01) | <0.01** | 1.324(1.037,1.690) | 0.024* | 1.03 | |
| Length of hospital stay in the previous year (times), Mean (SD) | 0.71(1.05) | 0.24(0.55) | <0.01** | ||||
| Comorbidities, n(%) | |||||||
| Hypertension | 7(2.93) | 7(3.15) | 1.000 | ||||
| Diabetes mellitus | 1(0.41) | 5(2.25) | 0.110 | ||||
| Coronary artery disease | 10(4.18) | 15(6.76) | 0.522 | ||||
| Bronchiectasis | 38(15.90) | 24(10.81) | 0.133 | 0.352(0.166,0.746) | <0.01** | 1.11 | |
| Lung cancer | 6(2.51) | 3(1.35) | 0.506 | ||||
| Asthma | 19(7.95) | 29(13.06) | 0.093 | ||||
| Bronchitis | 28(11.72) | 19(8.56) | 0.284 | ||||
| Pulmonary infection | 52(21.76) | 38(17.12) | 0.240 | ||||
| Pulmonary nodule | 47(19.67) | 44(19.82) | 1.000 | ||||
| Silicosis | 6(2.51) | 1(0.45) | 0.124 | 0.056(0.005,0.662) | 0.022* | 1.02 | |
| Inhalation therapies, n(%) | |||||||
| LABA | 9(3.77) | 9(4.05) | 1.000 | ||||
| LAMA | 9(3.77) | 16(7.21) | 0.148 | ||||
| LABA/LAMA | 68(28.45) | 38(17.12) | <0.01** | 0.359(0.191,0.674) | <0.01** | 1.02 | |
| LABA/ICS | 36(15.06) | 33(14.86) | 1.000 | ||||
| LAMA/ICS | 2(0.84) | - | 0.500 | ||||
| LABA/LAMA/ICS | 27(11.30) | 19(8.56) | 0.354 | ||||
| Antibiotics, n(%) | |||||||
| Fluoroquinolones | 63(26.40) | 58(26.13) | 0.290 | 3.555(1.206,10.480) | 0.021* | 1.05 | |
| Macrolides | 2(0.84) | 2(0.90) | 1.000 | ||||
| Lincosamides | 1(0.42) | 5(2.25) | 0.110 | 12.292(1.037,145.668) | 0.047* | 1.02 | |
| Cephalosporins | 19(7.95) | 5(2.25) | <0.01** | ||||
| Assessment | Patients with DRPs (n=239) | Patients without DRPs (n=222) | P value |
| mMRC Breathlessness Scale, n(%) | |||
| 0 Not troubled by breathlessness except on strenuous exercise | - | 6(2.70) | <0.01** |
| 1 Short of breath when hurrying or walking up a slight hill | 60(25.10) | 157(70.72) | |
| 2 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace | 103(43.10) | 56(25.23) | |
| 3 Stops for breath after walking about 100 meters or after a few minutes on level ground | 50(20.92) | 3(1.35) | |
| 4 Too breathless to leave the house, or breathless when dressing or undressing | 26(10.88) | - | |
| CAT, Mean (SD) | |||
| Cough | 2.26(0.98) | 1.45(0.87) | <0.01** |
| Phlegm | 2.20(0.86) | 1.13(0.71) | <0.01** |
| Chest tightness | 2.46(1.00) | 1.24(0.81) | <0.01** |
| Breathlessness | 2.97(1.12) | 1.37(0.88) | <0.01** |
| Activities | 2.69(1.13) | 0.99(0.61) | <0.01** |
| Confidence | 2.64(1.18) | 0.99(0.65) | <0.01** |
| Sleep | 2.34(1.01) | 1.03(0.65) | <0.01** |
| Energy | 2.36(1.01) | 0.94(0.54) | <0.01** |
| CAT score | 19.91(5.01) | 9.14(3.77) | <0.01** |
| CCQ, Mean (SD) | |||
| Short of breath while at rest | 2.27(1.18) | 0.99(0.69) | <0.01** |
| Short of breath while doing physical activities | 3.63(1.56) | 2.32(1.36) | <0.01** |
| Concerned about getting a cold or your breathing getting worse | 2.73(1.34) | 1.21(0.89) | <0.01** |
| Depressed (down) because of your breathing problems | 2.61(1.28) | 1.19(0.95) | <0.01** |
| Cough | 2.94(1.09) | 2.01(1.17) | <0.01** |
| Sputum or phlegm(chest mucus) | 2.87(0.99) | 1.76(1.05) | <0.01** |
| Strenuous physical activities | 3.75(1.42) | 2.50(1.58) | <0.01** |
| Moderate physical activities | 3.21(1.25) | 1.58(1.06) | <0.01** |
| Daily activities at home | 2.86(1.37) | 1.21(0.85) | <0.01** |
| Social activities | 2.42(1.30) | 0.96(0.65) | <0.01** |
| CCQ Points | 3.50(0.91) | 1.57(0.73) | <0.01** |
| CCQ-Symptoms | 2.93(0.69) | 1.77(0.73) | <0.01** |
| CCQ-Functional state | 3.06(1.17) | 1.56(0.89) | <0.01** |
| CCQ-Mental state | 2.67((1.27) | 1.20(0.87) | <0.01** |
| EQ-5D | |||
| Mobility, n(%) | |||
| I have no problems in walking about | 142 (59.41) | 216(97.30) | <0.01** |
| I have some problems in walking about | 77(32.22) | 2(0.90) | |
| I am confined to bed | 20(8.37) | 4(1.80) | |
| Self-care, n(%) | |||
| I have no problems with self-care | 145(60.67) | 221(99.55) | <0.01** |
| I have some problems washing or dressing myself | 78(32.64) | 1(0.45) | |
| I am unable to wash or dress myself | 16(6.69) | - | |
| Usual activity (e.g. work, study, housework, family or leisure activities), n(%) | |||
| I have no problems with performing my usual activities | 135(56.49) | 219(98.65) | <0.01** |
| I have some problems with performing my usual activities | 86(35.98) | 3(1.35) | |
| I am unable to perform my usual activities | 18(7.53) | - | |
| Pain/discomfort, n(%) | |||
| I have no pain or discomfort | 109(45.60) | 215(96.85) | <0.01** |
| I have moderate pain or discomfort | 110(46.03) | 5(2.25) | |
| I have extreme pain or discomfort | 20(8.37) | 2(0.90) | |
| Anxiety/depression, n(%) | |||
| I am not anxious or depressed | 138(57.74) | 217(97.75) | <0.01** |
| I am moderately anxious or depressed | 86(35.98) | 5(2.25) | |
| I am extremely anxious or depressed | 15(6.28) | - | |
| Self-rated health index, Mean (SD) | 58.47(16.37) | 76.68(11.00) | <0.01** |
| MMAM-4, n(%) | |||
| High (=4) | 59(24.69) | 43(19.37) | 0.208 |
| Medium (2-3) | 162(67.78) | 167(75.23) | |
| Low (0-1) | 18(7.53) | 12(5.40) |
表 5
Table 5 Risk factors associated with the occurrence of DRPs in outpatients with COPD (Clinical efficacy assessment aspects)
| Assessment | Patients with DRPs (n=239) | Patients without DRPs (n=222) | P value |
| mMRC Breathlessness Scale, n(%) | |||
| 0 Not troubled by breathlessness except on strenuous exercise | - | 6(2.70) | <0.01** |
| 1 Short of breath when hurrying or walking up a slight hill | 60(25.10) | 157(70.72) | |
| 2 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace | 103(43.10) | 56(25.23) | |
| 3 Stops for breath after walking about 100 meters or after a few minutes on level ground | 50(20.92) | 3(1.35) | |
| 4 Too breathless to leave the house, or breathless when dressing or undressing | 26(10.88) | - | |
| CAT, Mean (SD) | |||
| Cough | 2.26(0.98) | 1.45(0.87) | <0.01** |
| Phlegm | 2.20(0.86) | 1.13(0.71) | <0.01** |
| Chest tightness | 2.46(1.00) | 1.24(0.81) | <0.01** |
| Breathlessness | 2.97(1.12) | 1.37(0.88) | <0.01** |
| Activities | 2.69(1.13) | 0.99(0.61) | <0.01** |
| Confidence | 2.64(1.18) | 0.99(0.65) | <0.01** |
| Sleep | 2.34(1.01) | 1.03(0.65) | <0.01** |
| Energy | 2.36(1.01) | 0.94(0.54) | <0.01** |
| CAT score | 19.91(5.01) | 9.14(3.77) | <0.01** |
| CCQ, Mean (SD) | |||
| Short of breath while at rest | 2.27(1.18) | 0.99(0.69) | <0.01** |
| Short of breath while doing physical activities | 3.63(1.56) | 2.32(1.36) | <0.01** |
| Concerned about getting a cold or your breathing getting worse | 2.73(1.34) | 1.21(0.89) | <0.01** |
| Depressed (down) because of your breathing problems | 2.61(1.28) | 1.19(0.95) | <0.01** |
| Cough | 2.94(1.09) | 2.01(1.17) | <0.01** |
| Sputum or phlegm(chest mucus) | 2.87(0.99) | 1.76(1.05) | <0.01** |
| Strenuous physical activities | 3.75(1.42) | 2.50(1.58) | <0.01** |
| Moderate physical activities | 3.21(1.25) | 1.58(1.06) | <0.01** |
| Daily activities at home | 2.86(1.37) | 1.21(0.85) | <0.01** |
| Social activities | 2.42(1.30) | 0.96(0.65) | <0.01** |
| CCQ Points | 3.50(0.91) | 1.57(0.73) | <0.01** |
| CCQ-Symptoms | 2.93(0.69) | 1.77(0.73) | <0.01** |
| CCQ-Functional state | 3.06(1.17) | 1.56(0.89) | <0.01** |
| CCQ-Mental state | 2.67((1.27) | 1.20(0.87) | <0.01** |
| EQ-5D | |||
| Mobility, n(%) | |||
| I have no problems in walking about | 142 (59.41) | 216(97.30) | <0.01** |
| I have some problems in walking about | 77(32.22) | 2(0.90) | |
| I am confined to bed | 20(8.37) | 4(1.80) | |
| Self-care, n(%) | |||
| I have no problems with self-care | 145(60.67) | 221(99.55) | <0.01** |
| I have some problems washing or dressing myself | 78(32.64) | 1(0.45) | |
| I am unable to wash or dress myself | 16(6.69) | - | |
| Usual activity (e.g. work, study, housework, family or leisure activities), n(%) | |||
| I have no problems with performing my usual activities | 135(56.49) | 219(98.65) | <0.01** |
| I have some problems with performing my usual activities | 86(35.98) | 3(1.35) | |
| I am unable to perform my usual activities | 18(7.53) | - | |
| Pain/discomfort, n(%) | |||
| I have no pain or discomfort | 109(45.60) | 215(96.85) | <0.01** |
| I have moderate pain or discomfort | 110(46.03) | 5(2.25) | |
| I have extreme pain or discomfort | 20(8.37) | 2(0.90) | |
| Anxiety/depression, n(%) | |||
| I am not anxious or depressed | 138(57.74) | 217(97.75) | <0.01** |
| I am moderately anxious or depressed | 86(35.98) | 5(2.25) | |
| I am extremely anxious or depressed | 15(6.28) | - | |
| Self-rated health index, Mean (SD) | 58.47(16.37) | 76.68(11.00) | <0.01** |
| MMAM-4, n(%) | |||
| High (=4) | 59(24.69) | 43(19.37) | 0.208 |
| Medium (2-3) | 162(67.78) | 167(75.23) | |
| Low (0-1) | 18(7.53) | 12(5.40) |
| Interaction term | OR | 95% CI Lower | 95% CI Upper | P value |
| Smoking active × Bronchiectasis | 1.07 | 0.31 | 3.88 | 0.911 |
| Smoking active × Silicosis | 0.00 | - | 0.165 | |
| Smoking active × LABA+LAMA | 0.60 | 0.20 | 1.75 | 0.255 |
| Smoking active × Length of exacerbations in the previous year (times) | 1.05 | 0.68 | 1.62 | 0.815 |
| Smoking active × Fluoroquinolones | 0.77 | 0.28 | 2.16 | 0.625 |
表 6
Table 6 Potential interaction among risk factors related to drug-related problems (DRPs) in COPD outpatients
| Interaction term | OR | 95% CI Lower | 95% CI Upper | P value |
| Smoking active × Bronchiectasis | 1.07 | 0.31 | 3.88 | 0.911 |
| Smoking active × Silicosis | 0.00 | - | 0.165 | |
| Smoking active × LABA+LAMA | 0.60 | 0.20 | 1.75 | 0.255 |
| Smoking active × Length of exacerbations in the previous year (times) | 1.05 | 0.68 | 1.62 | 0.815 |
| Smoking active × Fluoroquinolones | 0.77 | 0.28 | 2.16 | 0.625 |
| Determinates | Male (n=386） | Female (n=75) | |||||||
| OR | 95% CI Lower | 95% CI Upper | P value | OR | 95% CI Lower | 95% CI Upper | P value | ||
| Age | 1.05 | 1.03 | 1.08 | <0.01** | 1.03 | 0.97 | 1.09 | 0.416 | |
| Bronchiectasis | 2.11 | 0.96 | 4.88 | 0.070 | 2.04 | 0.67 | 6.39 | 0.211 | |
| Silicosis | 9.67 | 1.44 | 197.02 | 0.047* | - | - | - | - | |
| Smoking active | 3.20 | 1.60 | 6.67 | <0.01** | 1.04 | 0.22 | 4.40 | 0.963 | |
| Length of exacerbations in the previous year (times) | 1.35 | 1.12 | 1.63 | <0.01** | 1.21 | 0.71 | 2.16 | 0.490 | |
| LABA+LAMA | 1.43 | 0.83 | 2.49 | 0.205 | 3.98 | 1.32 | 12.90 | 0.017* | |
| Fluoroquinolones | 1.12 | 0.67 | 1.85 | 0.671 | 0.85 | 0.25 | 2.71 | 0.786 | |
| Lincosamides | 0.22 | 0.01 | 1.53 | 0.182 | - | - | - | - | |
表 7
Table 7 Gender Stratification Analysis of Drug-related Problems (DRPs) in Outpatients with COPD
| Determinates | Male (n=386） | Female (n=75) | |||||||
| OR | 95% CI Lower | 95% CI Upper | P value | OR | 95% CI Lower | 95% CI Upper | P value | ||
| Age | 1.05 | 1.03 | 1.08 | <0.01** | 1.03 | 0.97 | 1.09 | 0.416 | |
| Bronchiectasis | 2.11 | 0.96 | 4.88 | 0.070 | 2.04 | 0.67 | 6.39 | 0.211 | |
| Silicosis | 9.67 | 1.44 | 197.02 | 0.047* | - | - | - | - | |
| Smoking active | 3.20 | 1.60 | 6.67 | <0.01** | 1.04 | 0.22 | 4.40 | 0.963 | |
| Length of exacerbations in the previous year (times) | 1.35 | 1.12 | 1.63 | <0.01** | 1.21 | 0.71 | 2.16 | 0.490 | |
| LABA+LAMA | 1.43 | 0.83 | 2.49 | 0.205 | 3.98 | 1.32 | 12.90 | 0.017* | |
| Fluoroquinolones | 1.12 | 0.67 | 1.85 | 0.671 | 0.85 | 0.25 | 2.71 | 0.786 | |
| Lincosamides | 0.22 | 0.01 | 1.53 | 0.182 | - | - | - | - | |
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