Are there specific clinical characteristics associated with physician’s treatment choices in COPD?

Abstract

Background The number of pharmacological agents and guidelines available for COPD has increased markedly but guidelines remain poorly followed. Understanding underlying clinical reasoning is challenging and could be informed by clinical characteristics associated with treatment prescriptions. Methods To determine whether COPD treatment choices by respiratory physicians correspond to specific patients’ features, this study was performed in 1171 patients who had complete treatment and clinical characterisation data. Multiple statistical models were applied to explain five treatment categories: A: no COPD treatment or short-acting bronchodilator(s) only; B: one long-acting bronchodilator (beta2 agonist, LABA or anticholinergic agent, LAMA); C: LABA+LAMA; D: a LABA or LAMA + inhaled corticosteroid (ICS); E: triple therapy (LABA+LAMA+ICS). Results Mean FEV1 was 60% predicted. Triple therapy was prescribed to 32.9% (treatment category E) of patients and 29.8% received a combination of two treatments (treatment categories C or D); ICS-containing regimen were present for 44% of patients altogether. Single or dual bronchodilation were less frequently used (treatment categories B and C: 19% each). While lung function was associated with all treatment decisions, exacerbation history, scores of clinical impact and gender were associated with the prescription of > 1 maintenance treatment. Statistical models could predict treatment decisions with a < 35% error rate. Conclusion In COPD, contrary to what has been previously reported in some studies, treatment choices by respiratory physicians appear rather rational since they can be largely explained by the patients’ characteristics proposed to guide them in most recommendations. Electronic supplementary material The online version of this article (10.1186/s12931-019-1156-1) contains supplementary material, which is available to authorized users.

Women's COPD

“…Even if women with COPD are more likely to have interactions with healthcare providers than men (32,35), they receive fewer classes of medications and non-pharmacologic interventions for COPD than men (22,33,36). Paradoxically, male are more likely to receive more than one maintenance drug, especially long-acting anti-muscarinic or dual long acting bronchodilators for COPD (37,38).…”

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

“…In several studies, male patients with COPD have been shown to be more likely to be prescribed more than one maintenance treatment, and a have greater likelihood of receiving anti‐muscarinic and dual long‐acting bronchodilators for COPD 151,152 . However, specific treatments targeting smoking may be prescribed more often for women 151 .…”

Nghiên Cứu Đặc Điểm Bệnh Nhân Bệnh Phổi Tắc Nghẽn Mạn Tính Giai Đoạn Ổn Định Được Điều Trị Với Thuốc Kháng Muscarinic Tác Dụng Kéo Dài Đơn Trị Tại Bệnh Viện Trường Đại Học Y Dược Cần Thơ

“…Trong nghiên cứu của chúng tôi có 66,7% bệnh nhân có FEV1≥ 50%, tương đồng với nghiên cứu của N. Roche năm 2019 với tỷ lệ bệnh nhân thuộc nhóm I và II là 62,7% và nghiên cứu của Nguyễn Đức Thọ năm 2018 với 66,4%. Có khác biệt với nghiên cứu của Nguyễn Văn Thành năm 2018 với tỷ lệ FEV1> 50% là 50,8% [8].…”