Clinical factors predictive of appropriate treatment in COPD: a community hospital setting

Sukanya Tongdee; Bundit Sawunyavisuth; Wattana Sukeepaisarnjaroen; Watchara Boonsawat; Sittichai Khamsai; Kittisak Sawanyawisuth

doi:10.33393/dti.2021.2291

Authors

Sukanya Tongdee Department of Medicine, Chumpae Hospital, Khon Kaen - Thailand
Bundit Sawunyavisuth Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen - Thailand
Wattana Sukeepaisarnjaroen Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand https://orcid.org/0000-0001-5065-9397
Watchara Boonsawat Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
Sittichai Khamsai Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
Kittisak Sawanyawisuth Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand https://orcid.org/0000-0003-3570-8474

DOI:

https://doi.org/10.33393/dti.2021.2291

Keywords:

CAT, Hospitalization, mMRC

Abstract

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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