Changes in pharmacotherapy of patients with chronic obstructive pulmonary disease at their discharge from the University Clinic Golnik

Kronična obstruktivna pljučna bolezen (KOPB) je razširjena bolezen, za katero je značilna obstrukcija v dihalnih poteh, ki je v veliki meri nepovratna, običajno napreduje in je povezana z nenormalnim vnetnim odzivom pljuč na vdihane dražeče delce in pline. Z retrospektivno raziskavo smo želeli ugotoviti, pri kolikšnem deležu bolnikov se je kronična terapija KOPB ob odpustu s Klinike Golnik spremenila, katere so bile najpogostejše spremembe in ali so bile te spremembe navedene v odpustnem pismu. Pregledali smo podatke 152 bolnikov, ki so imeli odpustno diagnozo KOPB. Popisali smo inhalacijsko in ostalo terapijo za zdravljenje KOPB, ki jo je bolnik prejemal pred sprejemom in ob odpustu iz bolnišnice. Glavni viri podatkov so bili bolnišnični informacijski sistem, kartica zdravstvenega zavarovanja in pogovori z bolniki. Med vzdrževalno inhalacijsko terapijo je bila najpogosteje predpisana kombinacija dolgodelujočega beta2-agonista, dolgodelujočega muskarinskega antagonista in inhalacijskega glukokortikoida tako ob sprejemu (65/13946,8 %) kot tudi ob odpustu (70/13950,4 %). Pri 66 od 133 bolnikov (49,6 %) je prišlo do sprememb v vzdrževalni inhalacijski terapiji. Najpogostejši spremembi sta bili uvedba zdravila (28/6642,4 %) in zamenjava zdravila znotraj iste farmakološke skupine zdravilnih učinkovin (20/6630,3 %). Inhalacijski glukokortikoid je imelo ob sprejemu predpisan 84 od 139 bolnikov (60,4 %), ob odpustu pa 94 od 139 bolnikov (67,6 %) ter več kot polovica bolnikov srednji odmerek inhalacijskega glukokortikoida in več kot tretjina bolnikov velik odmerek. Ob sprejemu je imelo dodatno vzdrževalno terapijo predpisano 14,4 % bolnikov (20/139), ob odpustu pa 13,9 % bolnikov (19/139), pri čemer je bil najpogosteje predpisan teofilin. Ob sprejemu 27,3 % bolnikov (38/139) ni imelo predpisane terapije po potrebi s kratkodelujočimi bronhodilatatorji, ob odpustu pa se je ta delež značilno znižal, in sicer na 18,0 % (25/139p = 0,026). Povezava med intervencijo kliničnega farmacevta in navedbami sprememb terapije v odpustnem pismu je bila značilna pri vzdrževalni inhalacijski terapiji (p = 0,003) in pri terapiji po potrebi s kratkodelujočimi bronhodilatatorji (p = 0,007), medtem ko je bila povezava med intervencijo kliničnega farmacevta in strokovno utemeljenostjo sprememb v odpustnem pismu značilna le pri terapiji po potrebi s kratkodelujočimi bronhodilatatorji (p = 0,045).Chronic obstructive pulmonary disease (COPD) is a common disease that is characterized by airway obstruction, which is extensively irreversible, usually progresses and is associated with abnormal inflammatory response of the lungs to inhaled noxious particles and gases. The aim of our retrospective study was to determine in what proportion of patients did the chronic therapy of COPD change at their discharge from the University Clinic Golnik, what were the most common changes and if the changes were documented in the discharge letter. The study included 152 patients with discharge diagnosis of COPD. We documented the use of inhalation and other therapy for the treatment of COPD before admission and compared it to the therapy prescribed upon discharge from the hospital. The main sources of data were the hospital information system, the list of pharmacy claims and conversations with patients. Of the maintenance inhaled therapy the most commonly prescribed combination was the one with long-acting beta2-agonist, long-acting muscarinic antagonist and inhaled corticosteroid both at admission (65/13946.8 %) and discharge (70/13950.4 %). In 66 of 133 patients (49.6 %) there was a change in maintenance inhaled therapy. The most common changes were drug initiation (28/6642.4 %) and drug substitution within the same pharmacological group of active substances (20/6630.3 %). 84 of 139 patients (60.4 %) had inhaled corticosteroid prescribed at admission and 94 of 139 (67.6 %) at their discharge with more than half of the patients prescribed a medium dose of inhaled corticosteroid and more than a third of patients a high dose. At admission 14.4 % of patients (20/139) were prescribed additional maintenance therapy in comparison with 13.9 % of patients (19/139) at discharge with theophylline being the most prescribed medication. At admission 27.3 % of patients (38/139) did not receive as-needed therapy with short-acting bronchodilators and at discharge this percentage significantly decreased to 18.0 % (25/139p = 0.026). The correlation between the intervention of a clinical pharmacist and the documenting of therapy changes in the discharge letter was significant in maintenance inhaled therapy (p = 0.003) and as-needed therapy with short-acting bronchodilators (p = 0.007), while the correlation between the intervention of a clinical pharmacist and the professional explanation of the changes in the discharge letter was significant only in the case of as-needed therapy with short-acting bronchodilators (p = 0.045)