摘要目的:比较2023年慢性阻塞性肺疾病全球倡议(GOLD 2023)发布后1年与前1年就诊的慢性阻塞性肺疾病(简称慢阻肺)患者吸入药物处方的差异，分析GOLD 2023对医师吸入药物处方的影响。方法:本研究为横断面研究，研究数据来源于RealDTC研究，研究对象为2021年11月14日至2023年11月15日在我国南方地区13家医院呼吸与危重症医学科就诊的慢阻肺患者。根据患者就诊的时间分为以下两组：GOLD 2023发布前1年组(2021年11月14日至2022年11月14日)，GOLD 2023发布后1年组(2022年11月15日至2023年11月15日)。收集患者的人口学特征、肺功能、症状评分、过去1年急性加重病史及吸入药物处方等。根据GOLD 2023慢阻肺患者的症状评分及过去1年急性加重病史分为A、B、E三组。比较GOLD 2023发布前后A、B、E组吸入药物治疗情况。结果:GOLD 2023发布前、后1年慢阻肺患者的慢阻肺评估测试(CAT)评分、改良版英国医学研究委员会呼吸困难问卷(mMRC)评分、过去1年急性加重次数差异有统计学意义(均 P<0.05)。与GOLD 2023发布前1年组相比，GOLD 2023发布后1年组的患者使用单药长效抗胆碱药物(LAMA)和吸入性糖皮质激素(ICS)＋长效β2受体激动剂(LABA)的比例更低，而使用LABA＋LAMA和ICS＋LABA＋LAMA的比例更高(均 P<0.05)。GOLD 2023发布前1年及后1年A组患者使用LAMA的比例差异无统计学意义( P>0.05)。相较于GOLD 2023发布前1年，GOLD 2023发布后1年A组患者处方使用ICS＋LABA的比例更低，而使用LABA＋LAMA、ICS＋LABA＋LAMA的比例更高(均 P<0.05)；B组患者处方使用LAMA、ICS＋LABA的比例更低(均 P<0.05)，使用LABA＋LAMA、ICS＋LABA＋LAMA的比例更高(均 P<0.05)；E组患者处方使用LAMA、ICS＋LABA的比例更低(均 P<0.05)，使用LABA＋LAMA、ICS＋LABA＋LAMA的比例更高(均 P<0.05)。 结论:GOLD 2023发布后A、B、E三组患者中ICS＋LAMA处方均有下降，LABA＋LAMA及ICS＋LABA＋LAMA处方均较前增多；然而，其实世界中，医师对GOLD 2023的依从性仍然不理想。

abstractsObjective:To compare the differences in inhaled medication prescriptions among patients with chronic obstructive pulmonary disease (COPD) who visited the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD 2023) one year after its release and the previous year, and to analyze the impact of GOLD 2023 on physician inhaled medication prescriptions.Methods:This study was a cross-sectional study, with data sourced from the RealDTC study. The study subjects were chronic obstructive pulmonary disease patients who visited the respiratory and critical care departments of 13 hospitals in southern China from November 14, 2021 to November 15, 2023. According to the time of patient visits, they are divided into the following two groups: the group 1 year before the release of GOLD 2023 (November 14, 2021 to November 14, 2022), and the group 1 year after the release of GOLD 2023 (November 15, 2022 to November 15, 2023). We collected demographic characteristics, lung function, symptom scores, history of acute exacerbation in the past year, and inhaled medication prescriptions from patients. According to the symptom score of COPD patients in GOLD 2023 and their history of acute exacerbation in the past year, they were divided into three groups: A, B, and E. The treatment status of inhaled drugs in groups A, B, and E before and after the release of GOLD 2023 was compared.Results:There were statistically significant differences in COPD Assessment Test (CAT) scores, Modified Medical Research Council (mMRC) scores, and the number of acute exacerbations in the past year between patients with COPD before and after the release of GOLD 2023 (all P<0.05). Compared with the group one year before the release of GOLD 2023, the proportion of patients in the group one year after the release of GOLD 2023 using long-acting muscarinic antagonists (LAMA) and inhaled corticosteroids (ICS)+ long-acting β2-receptor agonists (LABA) was lower, while the proportion of patients using LABA+ LAMA and ICS+ LABA+ LAMA was higher (all P<0.05). There was no statistically significant difference ( P>0.05) in the proportion of patients in group A using LAMA between the year before and after the release of GOLD 2023. Compared to the year before the release of GOLD 2023, the proportion of patients in group A who prescribed ICS+ LABA was lower, while the proportion of using LABA+ LAMA and ICS+ LABA+ LAMA was higher (all P<0.05); The proportion of patients in group B who prescribed LAMA and ICS+ LABA was lower (all P<0.05), while the proportion of using LABA+ LAMA and ICS+ LABA+ LAMA was higher (all P<0.05); The proportion of patients in group E who prescribed LAMA and ICS+ LABA was lower (all P<0.05), while the proportion of using LABA+ LAMA and ICS+ LABA+ LAMA was higher (all P<0.05). Conclusions:After the release of GOLD 2023, the prescription of ICS+ LAMA in groups A, B, and E decreased, and the prescriptions of LABA+ LAMA and ICS+ LABA+ LAMA increased compared to before; However, in the real world, the compliance of physicians with GOLD 2023 is still not ideal.