Clinical factors predictive of appropriate treatment in COPD: a community hospital setting
DOI:
https://doi.org/10.33393/dti.2021.2291Keywords:
CAT, Hospitalization, mMRCAbstract
Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease. The appropriate treatment according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline was 19-60%. However, there are limited data on predictors of appropriate treatment in patients with COPD. This study aimed to evaluate risk factors of appropriate treatment in patients with COPD according to the GOLD guideline in a real-world community setting.
Methods: This is a retrospective study conducted at a community hospital. Inclusion criteria were adult patients diagnosed as COPD treated at a COPD clinic. The primary outcome was the appropriate treatment, defined by correct pharmacological treatment by the GOLD guideline according to the ABCD severity assessment. Clinical predictors of appropriate treatment were executed by stepwise multivariate logistic regression analysis.
Results: 136 patients with COPD met the study criteria. Of those, 100 patients had inappropriate treatment according to the GOLD guideline. Three factors were independently associated with the appropriate treatment including number of admissions, modified Medical Research Council (mMRC) score, and CAT score. These factors had adjusted odds ratio of 3.11, 2.86, and 1.26, respectively. Causes of inappropriate treatment were unavailability of long-acting muscarinic antagonist (LAMA) (51 patients; 79.69%), treated by inhaled corticosteroid (ICS) alone (12 patients; 18.75%), and treated with only bronchodilator (1 patient; 1.56%).
Conclusions: Appropriate COPD patients’ treatment according to the GOLD guideline was 26.47% in community setting. Factors associated with severity of COPD were associated with prescribing appropriate treatments.
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References
Soriano JB, Abajobir AA, Abate KH, et al; GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691-706. https://doi.org/10.1016/S2213-2600(17)30293-X PMID:28822787 DOI: https://doi.org/10.1016/S2213-2600(17)30293-X
Kim WJ, Gupta V, Nishimura M, et al. Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities. Int J Tuberc Lung Dis. 2018;22(7):820-826. https://doi.org/10.5588/ijtld.17.0524 PMID:29914609 DOI: https://doi.org/10.5588/ijtld.17.0524
Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67(11):957-963. https://doi.org/10.1136/thoraxjnl-2011-201518 PMID:22684094 DOI: https://doi.org/10.1136/thoraxjnl-2011-201518
Dong F, Ren X, Huang K, Wang Y, Jiao J, Yang T. Development and validation of risk prediction model for in-hospital mortality among patients hospitalized with acute exacerbation: chronic obstructive pulmonary disease between 2015 and 2019. Front Med (Lausanne). 2021;8:630870. https://doi.org/10.3389/fmed.2021.630870 PMID:33889584 DOI: https://doi.org/10.3389/fmed.2021.630870
Bettoncelli G, Blasi F, Brusasco V, et al. The clinical and integrated management of COPD. Sarcoidosis Vasc Diffuse Lung Dis. 2014;31(suppl 1):3-21. https://doi.org/10.4081/mrm.2014.409PMID:24820963
Hashimoto N, Wakahara K, Sakamoto K. The importance of appropriate diagnosis in the practical management of chronic obstructive pulmonary disease. Diagnostics (Basel). 2021;11(4):618. https://doi.org/10.3390/diagnostics11040618 PMID:33808229 DOI: https://doi.org/10.3390/diagnostics11040618
Roche N, Plaza V, Backer V, et al. Asthma control and COPD symptom burden in patients using fixed-dose combination inhalers (SPRINT study). NPJ Prim Care Respir Med. 2020;30(1):1. https://doi.org/10.1038/s41533-019-0159-1 PMID:31911607 DOI: https://doi.org/10.1038/s41533-019-0159-1
Fernandes FLA, Cukier A, Camelier AA, et al. Recommendations for the pharmacological treatment of COPD: questions and answers. J Bras Pneumol. 2017;43(4):290-301. https://doi.org/10.1590/s1806-37562017000000153 PMID:29365005 DOI: https://doi.org/10.1590/s1806-37562017000000153
Foda HD, Brehm A, Goldsteen K, Edelman NH. Inverse relationship between nonadherence to original GOLD treatment guidelines and exacerbations of COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:209-214. https://doi.org/10.2147/COPD.S119507 PMID:28123293 DOI: https://doi.org/10.2147/COPD.S119507
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD, http://goldcopd.org/ (2021, accessed 26 April 2021).
Palmiotti GA, Lacedonia D, Liotino V, et al. Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. Int J Chron Obstruct Pulmon Dis. 2018;13:2455-2462. https://doi.org/10.2147/COPD.S157779 PMID:30147311 DOI: https://doi.org/10.2147/COPD.S157779
Chan KP, Ko FW, Chan HS, et al. Adherence to a COPD treatment guideline among patients in Hong Kong. Int J Chron Obstruct Pulmon Dis. 2017;12:3371-3379. https://doi.org/10.2147/COPD.S147070 PMID:29238182 DOI: https://doi.org/10.2147/COPD.S147070
Ding B, Small M, Holmgren U. A cross-sectional survey of current treatment and symptom burden of patients with COPD consulting for routine care according to GOLD 2014 classifications. Int J Chron Obstruct Pulmon Dis. 2017;12:1527-1537. https://doi.org/10.2147/COPD.S133793 PMID:28579771 DOI: https://doi.org/10.2147/COPD.S133793
Larsson K, Ekberg-Jansson A, Stridsman C, Hanno M, Vanfleteren LEGW. Adherence to treatment recommendations for chronic obstructive pulmonary disease – results from the Swedish National Airway Register. Int J Chron Obstruct Pulmon Dis. 2021;16:909-918. https://doi.org/10.2147/COPD.S300299 PMID:33854309 DOI: https://doi.org/10.2147/COPD.S300299
Price D, West D, Brusselle G, et al. Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns. Int J Chron Obstruct Pulmon Dis. 2014;9:889-904. https://doi.org/10.2147/COPD.S62750 PMID:25210450 DOI: https://doi.org/10.2147/COPD.S62750
Ramakrishnan S, Janssens W, Burgel PR, et al. Standardisation of clinical assessment, management and follow-up of acute hospitalised exacerbation of COPD: A Europe-wide consensus. Int J Chron Obstruct Pulmon Dis. 2021;16:321-332. https://doi.org/10.2147/COPD.S287705 PMID:33623379 DOI: https://doi.org/10.2147/COPD.S287705
Sawunyavisuth B. What are predictors for a continuous positive airway pressure machine purchasing in obstructive sleep apnea patients? Asia Pac J Sci Technol. 2018;23: APST-23-03-10. https://doi.org/10.14456/apst.2018.10
Kingkaew N, Antadech T. Cardiovascular risk factors and 10-year CV risk scores in adults aged 30-70 years old in Amnat Charoen Province, Thailand. Asia Pac J Sci Technol. 2019;24:APST-24-04-04. https://so01.tci-thaijo.org/index.php/APST/article/view/181250
Jingmark S, Kuhirunyaratn P, Theeranut A, et al. Subjective well-being and related factors among community-dwelling elderly in Udon Thani Province, Thailand. Asia Pac J Sci Technol. 2020;25:APST-25-01-09. https://so01.tci-thaijo.org/index.php/APST/article/view/201240
Chaiear N, Nirarach K, Kawamatawong T, et al. Proportion of workers having work-related asthma symptoms in a cassava factory, Nakhon Ratchasima province, Thailand. Asia Pac J Sci Technol. 2020;25:APST-25-02-08. https://so01.tci-thaijo.org/index.php/APST/article/view/239890
Mekov E, Nuñez A, Sin DD, et al. Update on asthma-COPD overlap (ACO): a narrative review. Int J Chron Obstruct Pulmon Dis. 2021;16:1783-1799. https://doi.org/10.2147/COPD.S312560 PMID:34168440 DOI: https://doi.org/10.2147/COPD.S312560
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Accepted 2021-10-19
Published 2021-11-13
