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

Abstract

Yuqin Zeng,1– 3 Shan Cai,1– 3 Yan Chen,1– 3 Jiaxi Duan,1– 3 Yiyang Zhao,1– 3 Xin Li,4 Libing Ma,5 Qimi Liu,6 Yingqun Zhu,7 Ming Chen,8 Meiling Zhou,9 Ping Chen1– 3 1Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People’s Republic of China; 3Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People’s Republic of China; 4Division 4 of Occupational Disease, Hunan Occupational Disease Prevention and Treatment Hospital, Changsha, Hunan, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Guilin, Guilin, Guangxi, People’s Republic of China; 7Department of Respiratory and Critical Care Medicine, The Third Hospital of Changsha, Changsha, Hunan, People’s Republic of China; 8Department of Respiratory and Critical Care Medicine, No.1 Traditional Chinese Medicine Hospital of Changde City, Changde, Hunan, People’s Republic of China; 9Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Huaihua City, Huaihua, Hunan, People’s Republic of ChinaCorrespondence: Ping ChenDepartment of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Ren Min Road, Changsha, Hunan 410011, People’s Republic of ChinaTel + 86-731-85295047Fax + 86-731-85295044Email [email protected]: 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 FEV1/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.Keywords: COPD, treatment, discrepancy, observational study

Keywords

• copd
• treatment
• discrepancy
• observational study