&lt;p&gt;Current Status of the Treatment of COPD in China: A Multicenter Prospective Observational Study&lt;/p&gt;

Zeng, Yuqin; Cai, Sanjun; Chen, Yan; Duan, Jia‐Xi; Zhao, Yiyang; Li, Xin; Ma, Liwei; Liu, Qimi; Zhu, Yingqun; Chen, Ming; Zhou, Meiling; Chen, Ping

doi:10.2147/copd.s274024

Cited by 23 publications

(37 citation statements)

References 32 publications

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“…The substantial burden of severe exacerbations, air ow limitation, and persistent symptoms in this study suggest suboptimal management of COPD in China. Accordingly, we found substantial discrepancies between the real-world treatment patterns and the treatment guidelines for clinical practice [15], supporting previous ndings [16,29] but providing evidence that these discrepancies are likely nationwide. The most prescribed maintenance therapies in the REAL study were ICS/LABA, ICS/LABA + LAMA, and LAMA; however, their prescription rates varied (range: 15.3-36.0%).…”

Section: Discussionsupporting

confidence: 88%

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REALizing and improving management of stable COPD in China: Results of a multicentre, prospective, observational study (REAL)

Wang

Cai

Cao

et al. 2022

Preprint

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Background Chronic obstructive pulmonary disease (COPD) management in China is far from adequate, with underdiagnosis and undertreatment being the major barriers to optimal care and improved patient outcomes. To better understand the burden of COPD and its management in China, real-world characterization of the severity and treatment of COPD across the country is needed. Methods We conducted a 52-week multicentre, prospective, observational study on outpatients (≥ 40 years old) diagnosed with COPD, enrolled from 50 secondary and tertiary hospitals across six geographical regions. Data were collected in routine clinical practice. Results Between December 2017 and August 2020, 5013 patients were enrolled and 4978 included in the analysis. Mean (standard deviation [SD]) age was 66.2 (8.9) years and 79.5% were male. Most COPD outpatients (90%) had moderate-to-very-severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease [GOLD] II–IV). Overall, the annual rate (per patient) of COPD exacerbations of any severity was 0.56 (95% confidence interval [CI]: 0.54–0.58). During 1-year, 1536 (30.8%) patients experienced ≥ 1 exacerbation of any severity and 960 (19.3%) patients had ≥ 1 exacerbation requiring hospitalization/emergency visit. The annual severe exacerbation rate was 0.31 (95% CI: 0.29–0.33). Mean (SD) COPD assessment test score was 14.6 (7.6) at baseline and 10.6 (6.8) at follow-up; however, 42–55% of patients had persistent dyspnoea, chest tightness and wheezing at 1-year. The most prescribed treatments were inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination (36.0%), ICS/LABA + long-acting muscarinic antagonist (LAMA) (17.7%) and LAMA monotherapy (15.3%). Among patients with high exacerbation risk (GOLD Groups C and D), 10.1% and 13.1, respectively, did not receive any long-acting inhalers; only 53.8% and 63.6% of Group C and D patients with ≥ 1 exacerbation during follow-up were prescribed ICS-containing therapy, respectively. Mean (SD) adherence (actual drug taken days/follow-up days) for long-acting inhalers was 59.0% (34.3). Mean (SD) score for the COPD questionnaire was 6.7 (2.4). Conclusions These results indicate a high burden of severe exacerbations and symptoms in Chinese outpatients with COPD, and low adherence with treatment guidelines, highlighting the need for more effective management nationwide. Trial Registration: The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362).

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Section: Discussionsupporting

confidence: 88%

“…These data further demonstrate that the population in the REAL study is nationally representative. Compared with previous studies [16,29], our study also comprised a larger patient population and included patients from a broader range of geographic regions.…”

Section: Discussionmentioning

confidence: 99%

REALizing and improving management of stable COPD in China: Results of a multicentre, prospective, observational study (REAL)

Wang

Cai

Cao

et al. 2022

Preprint

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“…However, a recent large sample study in our center showed 33.2% of COPD had poor inhaled drug adherence after 6 months of follow-up. 43 Referred to these data, pneumoconiosis with COPD have worse inhaled drug adherence despite similar baseline status. Second, assessment of medication adherence was based on self-reports which could introduce recall bias and inaccuracy in the data collected, when compared to other objective methods.…”

Section: Discussionmentioning

confidence: 92%

Adherence to Inhaled Therapy in Patients with COPD Associated to Pneumoconiosis

Peng¹,

Duan²,

Li³

et al. 2021

COPD

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Background Pneumoconiosis has high prevalence of chronic obstructive pulmonary disease (COPD), respiratory morbidity, and mortality. Objective The aim of the present study was to examine patient characteristics and adherence to inhaled therapy among pneumoconiosis with COPD in a real-world clinical setting. Methods A cohort of pneumoconiosis patients with COPD prescript with at least one type of long-acting inhaled drug was followed for adherence for 2 years. Demographic and COPD-related characteristics were collected in baseline. Results In baseline, after adjusting for age, dust exposure duration positively correlated with number of acute exacerbation (AE) frequency in the last year. There were close associations among COPD Assessment Tool (CAT) score, modified Medical Research Council Dyspnea Scale (mMRC) grade, number of AE, and pre-FEV 1 value. Of 296 participants originally recruited, 213 participants finished the 2-year follow-up for adherence. 122 (57.28%) were non-adherent to inhaled therapy. The most common reason for non-adherence was “relief of symptoms after short-term controller medication use” (53.28%). Patients who were non-adherent reported higher body mass index (BMI), less AE events in the last year, higher pre-FEV 1 value, higher post-FEV 1 value and low CAT, mMRC scores compared to adherent in baseline. High pre-FEV 1 value (OR = 1.04, CI = 1.018–1.064) and low mMRC scores (OR = 0.406, CI = 0.214–0.771) were risk factors found associated with non-adherence. Conclusion A majority of pneumoconiosis patients complicated with COPD have suboptimal inhaled therapy adherence. Evidence-based, adherence-enhancing interventions should be targeted on less severe subjects.

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“…Furthermore, the proportion of never-smokers was relatively high (36%). Therefore, the data could not show the real-life treatment of hospital-based COPD patients 30,32 , but underlined the necessity of management for COPD in primary care, for example, early diagnosis of at-risk patients, smoking cessation, regular pharmacological treatment.…”

Section: Discussionmentioning

confidence: 99%

Phenotype and management of chronic obstructive pulmonary disease patients in general population in China: a nationally cross-sectional study

Bao

Jia

Cong

et al. 2021

npj Prim. Care Respir. Med.

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This study aims to investigate the characteristics of the phenotype and management of chronic obstructive pulmonary disease (COPD) patients in the general population in China. We analyzed spirometry-confirmed COPD patients who were identified from a population-based, nationally representative sample in China. All participants were measured with airflow limitation severity based on post-bronchodilator FEV1 percent predicted, bronchodilator responsiveness, exacerbation history, and respiratory symptoms. Among a total of 9134 COPD patients, 90.3% were non-exacerbators, 2.9% were frequent exacerbators without chronic bronchitis, 2.0% were frequent exacerbators with chronic bronchitis, and 4.8% were asthma-COPD overlap. Less than 5% of non-exacerbators ever had pulmonary function testing performed. The utilization rate of inhaled medication in non-exacerbators, exacerbators without chronic bronchitis, exacerbators with chronic bronchitis, and asthma-COPD overlap was 1.4, 23.5, 29.5, and 19.4%, respectively. A comprehensive strategy for the management of COPD patients based on phenotype in primary care is urgently needed.

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<p>Current Status of the Treatment of COPD in China: A Multicenter Prospective Observational Study</p>

Cited by 23 publications

References 32 publications

REALizing and improving management of stable COPD in China: Results of a multicentre, prospective, observational study (REAL)

REALizing and improving management of stable COPD in China: Results of a multicentre, prospective, observational study (REAL)

Adherence to Inhaled Therapy in Patients with COPD Associated to Pneumoconiosis

Phenotype and management of chronic obstructive pulmonary disease patients in general population in China: a nationally cross-sectional study

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