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      Current Status of the Treatment of COPD in China: A Multicenter Prospective Observational Study

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          Abstract

          Background

          There is a large gap in the treatments for patients with COPD according to the Global Initiative for COPD (GOLD) recommendations. Determining the situation of therapies in the real world is necessary. This study aimed to characterize the real-world practical therapies of COPD and prognosis of patients after treatment for 1 year.

          Methods

          This study was a multicenter prospective observational study performed using a database set up by the Second Xiangya Hospital of Center South University. Detailed usage information for pharmacotherapies and nonpharmacotherapies for patients was collected, as well as the consistency of recommendations and patient adherence. Moreover, the effect of therapies after 1 year was calculated by comparing lung function and symptoms.

          Results

          Ultimately, 4,796 patients with COPD from 12 hospitals in China were eligible. LAMA (39.1%), LAMA + LABA/ICS (39.0%) and LABA/ICS (14.4%) were the top three inhalants. We found that 42.7% of Group A patients, 61.6% of Group B patients and 30% of Group C patients were following inappropriate therapy, especially overuse of ICS. Only 3.9% (95% CI 2.4, 5.4) of patients used oxygen therapy, and 1.8% (95% CI 1.5, 2.3) used noninvasive positive pressure ventilation at home. Among these patients, 33.2% had poor adherence. A total of 452 patients completed 1 year of follow-up. After 1 year of treatment, the lung function of FEV 1/FVC decreased ( P=0.001) and the mMRC score increased ( P<0.001). There was no change in CAT scores ( P>0.05).

          Conclusion

          This study highlights a significant discrepancy between recommendations for managing patients with COPD in GOLD report, and in real-world clinical practice in China. Over-prescription of ICS and under-prescription of nonpharmacologic therapy were common. The adherence to treatment of patients was poor, and the real-life treatment effectiveness was unsatisfactory. More attention should be paid to the implementation of recommendations and standardized administration of therapies.

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          Most cited references 35

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          Standardisation of spirometry.

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            Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

            Background Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database. Methods This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis. Results A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10). Conclusion COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms.
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              How far is real life from COPD therapy guidelines? An Italian observational study.

              According to the GOLD international guidelines, the treatment of chronic obstructive pulmonary disease (COPD) should be proportional to the severity of airflow obstruction graded according to FEV(1)% predicted. Regular treatment with long-acting bronchodilators should be prescribed for symptomatic patients with FEV(1) < 80%. Inhaled corticosteroids should be added in patients with FEV(1) < 50% predicted and frequent exacerbations. To investigate whether pulmonologists follow the GOLD guidelines when prescribing treatment for COPD. A multicenter, cross-sectional, observational study was carried out in 49 Pulmonary Units evenly distributed throughout the country. For each patient the demographic, clinical data and the current therapies were registered in an electronic database. 4094 patients (mean age: 70.9 ± 9.4; males 72.4%, female 27.6%) were enrolled. Disease severity was classified as: mild (745), moderate (1722), severe (923), very severe (704). Irrespective of disease severity, inhaled corticosteroids alone or in combination with long-acting bronchodilators were used in 15.2% and 66.8% of patients, respectively. The appropriateness of the pharmacological treatment of the COPD patients was defined in accordance with the GOLD recommendations. The treatment was appropriate in 37.9% of patients and inappropriate in 62.1%, p < 0.0001. The inappropriateness was due to under-prescription in 7.2% and to over-prescription in 54.9% of patients. The presence and the number of exacerbations represented an important trigger for over-prescription at stages I and II. This study shows that there is a poor relationship between the recommendations of the GOLD international guidelines and current clinical practice, and that exacerbations may play a role in over-prescription. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                copd
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                07 December 2020
                2020
                : 15
                : 3227-3237
                Affiliations
                [1 ]Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University , Changsha, Hunan, People’s Republic of China
                [2 ]Research Unit of Respiratory Disease, Central South University , Changsha, Hunan, People’s Republic of China
                [3 ]Hunan Centre for Evidence-Based Medicine , Changsha, Hunan, People’s Republic of China
                [4 ]Division 4 of Occupational Disease, Hunan Occupational Disease Prevention and Treatment Hospital , Changsha, Hunan, People’s Republic of China
                [5 ]Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University , Guilin, Guangxi, People’s Republic of China
                [6 ]Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Guilin , Guilin, Guangxi, People’s Republic of China
                [7 ]Department of Respiratory and Critical Care Medicine, The Third Hospital of Changsha , Changsha, Hunan, People’s Republic of China
                [8 ]Department of Respiratory and Critical Care Medicine, No.1 Traditional Chinese Medicine Hospital of Changde City , Changde, Hunan, People’s Republic of China
                [9 ]Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Huaihua City , Huaihua, Hunan, People’s Republic of China
                Author notes
                Correspondence: Ping Chen Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University , 139 Middle Ren Min Road, Changsha, Hunan410011, People’s Republic of ChinaTel + 86-731-85295047Fax + 86-731-85295044 Email pingchen0731@csu.edu.cn
                Article
                274024
                10.2147/COPD.S274024
                7732160
                © 2020 Zeng et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 18, References: 39, Pages: 11
                Funding
                Funded by: National Key Clinical Specialty Construction Projects;
                Funded by: National Natural Science Foundation of China, open-funder-registry 10.13039/501100001809;
                Funded by: Xiangya Mingyi grant;
                This work was supported by the National Key Clinical Specialty Construction Projects, the National Natural Science Foundation of China (NSFC, Grants 81770046), NSFC (Grants 1970044) and Xiangya Mingyi grant (2013).
                Categories
                Clinical Trial Report

                Respiratory medicine

                observational study, copd, treatment, discrepancy

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