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Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD.

ABSTRACT: Objective:To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting. Methods:This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA. Results:Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%). Conclusion:The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.

SUBMITTER: Grewe FA

PROVIDER: S-EPMC7105357 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD.

Grewe Fabian A FA Sievi Noriane A NA Bradicich Matteo M Roeder Maurice M Brack Thomas T Brutsche Martin H MH Frey Martin M Irani Sarosh S Leuppi Jörg D JD Thurnheer Robert R Clarenbach Christian F CF Kohler Malcolm M

International journal of chronic obstructive pulmonary disease 20200326

<h4>Objective</h4>To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting.<h4>Methods</h4>This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for ...[more]

PMID: 32273691

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Project description:Main risk factor for the development of chronic obstructive pulmonary disease (COPD) is smoking, although only less than 1/3 of smokers develop clinically manifest COPD. COPD's progressive nature with high disability and mortality makes it plausible to detect it as early as possible thus allowing for an early intervention. The only tool for an early diagnosis that could be used on the global scale is spirometry, even though symptoms and deprivation of health related quality of life (HRQoL) precede relevant spirometric changes. Existing HRQoL questionnaires are too complicated or not developed for an early detection of COPD. The aim of our study was to develop a new simple HRQoL tool that will allow (alone or in combination with other markers) early detection of patients with COPD.A multicenter prospective cohort study recruiting 500 subjects at risk for COPD (smokers/ex-smokers ?20 pack-years, 40-65 years, both sexes, with no prior diagnosis of COPD) will be carried out in two phases: (1) cross-sectional - development and validation of a new questionnaire; and (2) prospective - follow-up of a cohort of patients at risk for COPD. Subjects were recruited by 25 GPs and assessed for COPD by dedicated pulmonologists in 7 hospital centers using a predefined protocol: HRQoL, history, physical, blood sampling, exhaled breath temperature (EBT), lung function, 6-min walk test (6MWT). Patients without COPD and those in GOLD stage 1 at initial assessment will be reassessed for disease progression by the same pulmonologist after 2 and 5 years.This is one of the first cohort studies attempting to establish the incidence of COPD in the pre-symptomatic stage before significant end organ damage. We intend to assess the validity, predictability and discriminative power ('healthy' smokers vs. pre-symptomatic phase in newly developed COPD) of newly developed HRQoL tool alone or in combination with other markers; EBT, lung function, 6MWT, genomics, transcriptomics, proteomics). We expect that the results of this study can improve our understanding of the development of COPD, identify some new underlying pathophysiological pathways, and offer to sensitive smokers/ex-smokers new preventive and early intervention measures thus improving the management of COPD.Clinicaltrial.gov NCT01550679 retrospectively registered February 28, 2012.

Project description:BACKGROUND:Although frailty is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients, evidence on the frequency of frailty transition is scarce. AIMS:The present study aimed to describe the frailty status transition rates over a 2-year period and their associated clinical outcomes in stable COPD patients, and to determine predictors of improvement in frailty status. METHODS:We prospectively included 119 patients with stable COPD (mean age ± SD, 66.9 ± 7.9 years) over a follow-up period of 2 years. Frailty was assessed using the Fried criteria (unintentional weight loss, weakness, exhaustion, low activity level, and slow walking speed). Several demographic, clinical, and health-related variables were measured. We calculated the rates for each of the frailty transitions (no change, improvement, or worsening) between baseline and 2 years. Outcomes were compared using one-way analysis of variance and predictors of improvement were identified in multivariate logistic regression. RESULTS:After 2 years of follow-up, 21 (17.6%) patients had an improved frailty status, 14 (11.7%) had worsened, and 84 (70.5%) had maintained the same frailty status. The worsening group (vs no change group) had greater dyspnea (p = 0.013) and disability (p = 0.036) and lower handgrip strength (p = 0.001). In contrast, the improved group (vs no change group) had greater handgrip (p<0.001) and quadriceps strength (p = 0.032). Furthermore, the improved group had greater handgrip strength (p<0.001), quadriceps strength (p = 0.003), physical activity (p = 0.008), and lower disability (p = 0.019) than the worsening group. Additionally, we determined that the 5STS test (? 13.6s) and exacerbations (? 2) were independent predictors for improvement in frailty status [adjusted OR 9.46, p = 0.058 and adjusted OR 0.12, p = 0.026, respectively]. CONCLUSIONS:Frailty is a dynamic process for approximately one-third of patients with stable COPD and transitions in frailty status are associated with significant changes in clinical outcomes. The 5STS and exacerbations were independent predictors of improvement in frailty status.

Project description:BACKGROUND:Despite the frequency and negative impact of low physical activity among patients with chronic obstructive pulmonary disease (COPD), little is known about how it persists and remits over time or the factors predicting new states of low physical activity. The aim of the study was to determine the probability of a transition between states of low and nonlow physical activity in a cohort of patients with stable COPD followed for 2?years. We also investigated different potentially modifiable factors to determine whether they can predict new states of low physical activity. METHODS:We prospectively included 137 patients with stable COPD (mean age 66.9?±?8.3?years). Physical activity was measured at baseline and at 1 and 2?years of follow up. Low physical activity was defined according to energy expenditure by cut-off points from the Fried frailty model. The likelihood of annual transition towards new states and recovery was calculated. We evaluated demographic, frailty, nonrespiratory, and respiratory variables as potential predictors, using generalized estimating equations. RESULTS:At baseline, 37 patients (27%) presented with low physical activity. During the study period, a total of 179 annual transitions were identified with nonlow physical activity at the beginning of the year; 17.5% transitioned to low physical activity. In contrast, 34.3% of the 67 transitions that started with low physical activity recovered. Predictors of transition to new states of low physical activity were dyspnea ?2 (odds ratio?=?3.21; 95% confidence interval: 1.20-8.61) and poor performance on the five sit-to-stand test (odds ratio?=?4.75; 95% confidence interval: 1.30-17.47). CONCLUSIONS:The change between levels of low and nonlow physical activity is dynamic, especially for recovery. Annual transitions toward new states of low physical activity are likely among patients with dyspnea or poor performance on the five sit-to-stand test. The reviews of this paper are available via the supplemental material section.

Project description:IntroductionThe concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: "Czech" COPD phenotypes and their most frequent combinations, "Spanish" phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk.MethodsData were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary "Czech" phenotypes and their most frequent and relevant combinations, "Spanish" phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test.ResultsThe cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV1 44.4% pred. KM estimates showed bronchiectases/COPD overlap (HR 1.425, p=0.045), frequent exacerbator (HR 1.58, p<0.001), cachexia (HR 2.262, p<0.001) and emphysematous (HR 1.786, p=0.015) phenotypes associated with higher mortality risk. Co-presence of multiple phenotypes in a single patient had additive effect on risk; combination of emphysema, cachexia and frequent exacerbations translated into poorest prognosis (HR 3.075; p<0.001). Of the "Spanish" phenotypes, AE CB and AE non-CB were associated with greater risk of mortality (HR 1.787 and 2.001; both p=0.001). FEV1% pred., cachexia and chronic heart failure in patient history were the major underlying factors determining mortality risk in our cohort.ConclusionCertain phenotypes ("Czech" or "Spanish") of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.

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Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD.

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Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD.

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