Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany; Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, University Hospitals of Gießen and Marburg, Marburg site, German Center for Lung Research (DZL); Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nürnberg, Paracelsus Medical University, Nürnberg, Germany.
Dtsch Arztebl Int. 2018 Sep 14;155(37):599-605. doi: 10.3238/arztebl.2018.0599.
Chronic obstructive pulmonary disease (COPD) is common around the world and carries a high morbidity and mortality. Symptom- and risk-oriented drug treatment is recommended, both in Germany and in other countries. It is not yet known to what extent the treatment that is actually delivered in Germany corresponds to the current recommendations in the guidelines.
As recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2017, 2281 patients of the national COPD cohort COSYCONET (COPD and Systemic Consequences-Comorbidities Network) were classified into Gold classes A-D on the basis of disease-specific manifestations and the frequency of exacerbations. Moreover, the regular use of medications was documented and categorized according to active substance groups. For all groups, the documented treatment that was actually given was compared to the recommended treatment.
67.6% of the patients received a combination of a long-acting anticholinergic drug (LAMA) and a long-acting beta-mimetic drug (LABA), while 65.8% received inhaled corticosteroids (ICS), 11.7% theophylline, and 12.6% oral corticosteroids (OCS). Despite recommendations to the contrary, 66% of the patients in Groups A and B (low exacerbation rates) were treated with ICS; some of these patients carried an additional diagnosis of bronchial asthma. There was evidence of undertreatment mainly in groups C and D (high exacerbation rate), because many of the patients in these groups were not treated with LAMA or LAMA/LABA as recommended.
The observed deviations from the recommended treatment, some of which were substantial, might lead to suboptimal treatment outcomes as well as to avoidable side effects of medication.
慢性阻塞性肺疾病（COPD）在全球范围内较为常见，其发病率和死亡率均较高。在德国和其他国家，均推荐根据症状和风险进行药物治疗。目前尚不清楚德国实际提供的治疗在多大程度上符合指南中的现行建议。
根据全球慢性阻塞性肺疾病倡议（GOLD）在 2017 年的建议，根据疾病的具体表现和加重频率，将全国性 COPD 队列 COSYCONET（COPD 和全身后果-合并症网络）中的 2281 例患者分为 GOLD A-D 级。此外，还记录了常规药物使用情况，并根据活性物质组进行了分类。对于所有组别，均将实际给予的记录治疗与推荐治疗进行了比较。
67.6%的患者接受了长效抗胆碱能药物（LAMA）和长效β激动剂（LABA）的联合治疗，而 65.8%接受了吸入皮质激素（ICS），11.7%接受了茶碱，12.6%接受了口服皮质激素（OCS）。尽管有相反的建议，但 A 和 B 组（低加重率）的 66%的患者仍接受了 ICS 治疗；其中一些患者还伴有支气管哮喘的额外诊断。在 C 和 D 组（高加重率）中主要存在治疗不足的情况，因为这些组中的许多患者未按建议接受 LAMA 或 LAMA/LABA 治疗。
观察到的与推荐治疗的偏差，其中一些是实质性的，可能导致治疗效果不理想，并导致药物的不可避免的副作用。
