Update on guidelines for the treatment of COPD in Taiwan using evidence and GRADE system-based recommendations

Cheng, Shih-Lung; Lin, Ching‐Hsiung; Chu, Kuo-An; Chiu, Kuo-Liang; Lin, Sheng‐Hao; Lin, Horng‐Chyuan; Ko, Hsin-Kuo; Chen, Yung‐Che; Chen, Chia-Hung; Sheu, Chau‐Chyun; Huang, Wei-Chang; Yang, Tsung‐Ming; Wei, Yufeng; Chien, Jung-Yien; Wang, Hao-Chien; Lin, Meng‐Chih

doi:10.1016/j.jfma.2021.06.007

Cited by 14 publications

(11 citation statements)

References 172 publications

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“…Initially, a generic pathway outlining the steps to COPD care was drafted for each country based on the GOLD recommendations. It was further refined using country-specific guidelines (18)(19)(20)(21)(22)(23). The pathways were then used as a visual aid in the clinician interviews to assess how current care delivery deviates from guideline provisions.…”

Section: Methodsmentioning

confidence: 99%

Mapping the common barriers to optimal COPD care in high and middle-income countries: qualitative perspectives from clinicians

Shahaj,

Meiwald,

Sudhir

et al. 2023

Preprint

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BackgroundAlthough predominantly preventable and treatable, chronic obstructive pulmonary disease (COPD) is a leading cause of death globally. Guidelines for managing the condition are widely available, yet COPD care remains suboptimal in many settings, including high and middle-income countries (HICs and MICs). Several approaches are used to diagnose and manage COPD, resulting in substantial variation in its care pathways. This study aimed to explore how barriers to optimal COPD care vary across HICs and MICs by identifying common and unique barriers to COPD care in six countries to inform global policy initiatives for better care while addressing specific challenges.MethodsBased on international and national guidelines, we mapped COPD care pathways for Australia, Spain, Taiwan, Argentina, Mexico, and Russia. Country-specific pathways were populated with published epidemiological, health economic, and clinical data identified through a pragmatic literature review. Semi-structured interviews with 17 respiratory care clinicians further informed and validated the pathways, data inputs, and key issues arising in each country. Thematic content analysis was used to analyse common and unique barriers across countries.ResultsSix themes were common in most HICs and MICs:“Challenges in COPD diagnosis”, “Strengthening the role of primary care”, “Fragmented healthcare systems and coordination challenges”, “Inadequate management of COPD exacerbations”; “Limited access to specialised care” and, “Impact of underfinanced and overloaded healthcare systems”. One theme,“Insurance coverage and reimbursement challenges”, was more relevant for MICs.HICs and MICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and specialised care availability. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. MICs also grapple with resource limitations and healthcare infrastructure challenges.ConclusionMany challenges to COPD care are the same in both HICs and MICs, underscoring the pervasive nature of these issues. While country-specific issues require customised solutions, there are untapped possibilities for implementing global respiratory strategies that motivate countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritisation of COPD to secure the essential resources it requires.

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Section: Methodsmentioning

confidence: 99%

Mapping the common barriers to optimal COPD care in high and middle-income countries: qualitative perspectives from clinicians

Shahaj,

Meiwald,

Sudhir

et al. 2023

Preprint

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“…Patients who met the inclusion criteria received comprehensive pharmacologic and nonpharmacologic treatment from a multi-disciplinary team consisting of pulmonary specialists, otorhinolaryngologists, pediatric specialists, family medicine specialists, respiratory therapists, pharmacists, and case managers. And diseases management based on Taiwan’s COPD guidelines [ 10 ]. The nonpharmacological intervention included pulmonary rehabilitation, smoking cessation, patient and family education, as well as integrated disease-specific information and health care resource integration.…”

Section: Methodsmentioning

confidence: 99%

The impact of the duration of the integrated disease management program on COPD-related outcomes

Lin

Wang

et al. 2023

Eur J Med Res

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Background The aim of this study is to assess the impact of the duration of the integrated disease management (IDM) program on COPD-related outcomes in real-world setting. Methods A retrospective cohort study among 3771 patients with COPD who had regularly completed 4 visits of IDM program within 1 year between April 1, 2017 and December 31, 2018. CAT score as the primary outcome used to investigate the association between IDM intervention duration and improvement in CAT score. Change in CAT score from baseline to each follow-up visit determined by using least-squares means (LSMeans) approach. The cut-off value of IDM duration for improving the CAT score was determined by the Youden index. Logistic regression was used to analyze the relationship between IDM intervention duration and MCID (the minimal clinically important difference) improvement in CAT score and the factor associated CAT improvement. Risks of COPD exacerbation events (COPD-related ED visit and COPD-related hospitalization) were estimated by using the cumulative incidence curve and Cox proportional hazards models. Result Among 3771 enrolled COPD patients, the majority of the study cohort were males (91.51%) and 42.7% of patients had CAT score of ≥ 10 at baseline. The mean of age was 71.47 years and the mean CAT at baseline were 10.49. The mean change from baseline in CAT score was − 0.87, − 1.19, − 1.23 and − 1.40 at 3-, 6-, 9- and 12 month follow-up (p < 0.0001 for all visits), respectively. Statistically significantly lower likelihood of achieving MCID improvement in CAT were observed at 3- and 6 month compared to 9 month (at 3 month: OR: 0.720, 95% CI 0.655–0.791; at 6 month: OR: 0.905, 95% CI 0.825–0.922). And only a modest increase likelihood of achieving MCID improvement in CAT at 12 month (OR: 1.097, 95% CI 1.001–1.201) compared with 9-month follow-up. In logistic regression on the entire cohort, CAT MCID improvement was most associated with baseline CAT scores ≥ 10, followed by frequent exacerbation in previous year (> 2 episodes/year), wheezing, and GOLD B or D at baseline. In baseline CAT ≥ 10 group, patients were more likely to achieve CAT MCID improvement and had greater decreases from baseline in CAT score observed at 3-, 6-, 9-, and 12 month compared with baseline CAT score < 10 group (all p < 0.0001). Moreover, in CAT ≥ 10 groups, patients who achieved CAT MCID improvement had lower risk of subsequent COPD exacerbation events (COPD-related ED visit: aHR: 1.196, 95% CI 0.985–1.453, p = 0.0713; COPD-related hospitalization: aHR: 1.529, 95% CI 1.215–1.924, p = 0.0003) when compared to those without. Conclusion This is the first real-world study indicating the association between COPD IDM intervention duration and COPD-related outcomes. From 3 to 12 month follow-up results showed that continued improvement over time in COPD-specific health status, particularly in patients with baseline CAT score of ≥ 10. Furthermore, a reduction of the risk of subsequent COPD exacerbations were observed in patients with CAT MCID improvement.

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“…The diagnosis and severity of COPD was defined according to GOLD guideline. 5 The inclusion criteria were absence of acute exacerbations for 3 months before recruitment, ability to ambulate for completion of CPET and PR, and willingness to be included in the study. The exclusion criteria were a history of other lung diseases such as asthma, pulmonary tuberculosis, etc., orthopedic or neurological impairment that unable to perform CPET and PR, unwilling to participate in the PR programs and those had ever participated in a PR program.…”

Section: Methodsmentioning

confidence: 99%

Different Responses to Pulmonary Rehabilitation in COPD Patients with Different Work Efficiencies

Jao¹,

Hsieh²,

Wu³

et al. 2022

COPD

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Background Chronic obstructive pulmonary disease (COPD) often involves the cardiopulmonary dysfunction that deteriorates health-related quality of life (HRQL) and exercise capacity. Work efficiency (WE) indicates the efficiency of overall oxygen consumption (VO 2 ) during exercise. This study investigated whether different WEs have different effects on pulmonary rehabilitation (PR). Methods Forty-five patients with stable COPD were scheduled for PR. The PR programs consisted of twice-weekly sessions for three months. These patients were comprehensively evaluated by cardiopulmonary exercise testing and COPD assessment test (CAT) before and after PR. We compared these parameters between patients with a normal versus poor WE. Results Twenty-one patients had a normal WE and twenty-four patients had a poor WE (<8.6 mL/min/watt). Patients with a poor WE had earlier anaerobic metabolism, a poorer oxygen pulse, lower exercise capacity, more exertional dyspnea, and a poorer HRQL than those with a normal WE. PR improved exercise capacity, HRQL, anaerobic threshold, exertional dyspnea and leg fatigue in patients with either normal or poor WE. However, significant improvement of WE, oxygen pulse, respiratory frequency (Rf) during exercise, chest tightness, activity and sleepiness by CAT were noted only in patients with a poor WE. Among the patients with a poor WE, 29% patients had WE returned to normal after PR. Conclusion Patients with different WE had different responses to PR. PR improved exercise capacity and HRQL regardless of a normal or poor WE. However, WE, oxygen pulse, Rf during exercise, chest tightness, activity and sleepiness were only improved in patients with a poor WE.

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Update on guidelines for the treatment of COPD in Taiwan using evidence and GRADE system-based recommendations

Cited by 14 publications

References 172 publications

Mapping the common barriers to optimal COPD care in high and middle-income countries: qualitative perspectives from clinicians

Mapping the common barriers to optimal COPD care in high and middle-income countries: qualitative perspectives from clinicians

The impact of the duration of the integrated disease management program on COPD-related outcomes

Different Responses to Pulmonary Rehabilitation in COPD Patients with Different Work Efficiencies

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