급여불인정불인정 대상모두하나만제한선행 치료평가·계속진단·검사수치서류필수 택일
각 약제의 허가사항 범위 내에서 아래와 같은 기준으로 투여 시 요양급여를 인정하며, 동 인정기준 이외에는 약값 전액을 환자가 부담토록 함.
- 아 래 -
가.부분조절 이상 단계의 천식 단, 3～6개월에 한번씩 평가를 실시하여 평가결과를 기재토록 함.
나.만성폐쇄성폐질환
1)FEV1 값이 예상 정상치의 60% 미만인 경우 또는
2)베타-2 작용제나 항콜린제 등의 지속 투여에도 연 2회 이상 급성악화※가 발생한 경우에는 투여소견서 참조하여 인정
※급성악화는 호흡곤란의 악화, 기침의 증가, 가래양의 증가 또는 가래색의 변화 등으로 약제의 변경 또는 추가(항생제？스테로이드제 등)가 필요한 경우를 말함.
*시행일: 2015.12.1
*변경사유:국내？외 가이드라인 등에서 COPD의 고위험 분류에 악화 횟수를 권고하는 점 및 급성악화의 정의 참조하여 기존 약제 지속투여에도 급성악화가 연2회 이상 발생되어 약제의 변경이 필요한 경우 투여소견서 참조하여 급여인정함.
*관련근거
·Ferri's Clinical Advisor 2015. Chronic Obstructive Pulmonary Disease. Basic Information Definition
·Current diagnosis & treatment 34: Chronic Obstructive Pulmonary Disease
·Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e;Chapter 36. Pulmonary Pharmacology
·Pharmacotherapy: A Pathophysiologic Approach, 9e 2014 ; Chapter 16. Chronic Obstructive Pulmonary Disease Pharmacologic Therapy
·Global Initiative for Chronic Obstructive Lung Disease - Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.(revised 2014).
·COPD 진료지침 2014 개정판, 대한결핵 및 호흡기학회 COPD 진료지침 개정위원회
·Chronic obstructive pulmonary disease Management of chronic obstructive pulmonary disease in adults in primary and secondary care: NICE clinical guidance 101 (Issue date: June 2010)
·American College of Physicians, American College of Chest Physicians, American Thoracic Society, European Respiratory Society. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011 Aug 2;155(3):179-191.
·Nannini LJ1, Poole P, Milan SJ, Kesterton A.Combined corticosteroid and long-acting beta(2) -agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Aug 30;8:CD006826.
·Nannini LJ1, Lasserson TJ, Poole P.Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus long-acting beta(2)-agonists for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2012 Sep 12;9:CD006829.
·Fukuchi Y1, et al. Budesonide/formoterol via Turbuhaler® versus formoterol via Turbuhaler® in patients with moderate to severe chronic obstructive pulmonary disease: phase III multinational study results. Respirology. 2013 Jul;18(5):866-73.
·Jenkins CR1, et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res. 2009 Jun 30;10:59.
·LINDBERG A, SZALAI Z, PULLERITS T, RADECZKY E. Fast onset of effect of budesonide/formoterol versus salmeterol/fluticasone and salbutamol in patients with COPD and reversible airway obstruction Respirology 2007; 12: 732？-739
·Chong J1, Leung B, Poole P.Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Nov 4;11:CD002309.
·Hanania NA1, et al. Pooled subpopulation analyses of the effects of roflumilast on exacerbations and lung function in COPD. Respir Med. 2014 Feb;108(2):366-75. doi: 10.1016/j.rmed.2013.09.018. Epub 2013 Sep 30.
·Rabe KF1, et al. Roflumilast--an oral anti-inflammatory treatment for chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 2005 Aug 13-19;366(9485):563-71.