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Evaluación del uso de inhaladores controlados por formulario en pacientes hospitalizados con presunta enfermedad
Noah S Ball1, Eric M Kinney1, Erin McMahan1
1WVU Medicine - WVU Hospitals; Morgantown, WV.
Journal of the American Pharmacists Association : JAPhA
|September 5, 2025
Resumen
El uso inadecuado de corticosteroides inhalados (ICS) es común en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) del grupo B debido a limitaciones de la fórmula. Esto aumenta los riesgos de eventos adversos como la neumonía, lo que pone de relieve la necesidad de un mejor acceso al inhalador.
Área de la Ciencia:
- Medicina de los pulmones
- Farmacoeconomía
- Farmacia clínica
Sus antecedentes:
- Se recomienda el tratamiento combinado con antagonistas muscarínicos de acción prolongada (LAMA) y agonistas beta de acción prolongada (LABA) para la enfermedad pulmonar obstructiva crónica del grupo B (EPOC).
- Los corticosteroides inhalados (ICS) pueden no ofrecer ningún beneficio y aumentar los riesgos en esta población.
- Las restricciones en el formulario para pacientes hospitalizados pueden conducir a un uso inadecuado de ICS y a eventos adversos.
Objetivo del estudio:
- Evaluar la idoneidad de la prescripción de ICS en pacientes hospitalizados con presunta EPOC del Grupo B.
- Determinar la incidencia de eventos adversos asociados con el ICS en esta cohorte.
Principales métodos:
- Estudio de cohorte retrospectivo de 100 pacientes con presunta EPOC del grupo B.
- Datos de registros electrónicos de salud (EPIC) utilizados desde julio de 2022 hasta septiembre de 2023.
- Se excluyeron los pacientes con adherencia previa a ICS, exacerbaciones recientes, asma o sin reconciliación de la medicación.
Principales resultados:
- El 14% de los pacientes recibieron terapia ICS contraria a las directrices de GOLD.
- El 14% de estos pacientes experimentaron una posible neumonía asociada con el ICS.
- La disponibilidad del inhalador puede influir en la prescripción inadecuada de ICS.
Conclusiones:
- Las limitaciones del formulario para pacientes hospitalizados pueden contribuir al uso inadecuado de ICS en la EPOC del Grupo B.
- La falta de disponibilidad de inhaladores LAMA/LABA puede conducir al uso de ICS.
- Abordar las restricciones formularizadas es crucial para optimizar el manejo de la EPOC.
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