Mangold Veronika, Boesing Maria, Berset Camille, Bridevaux Pierre-Olivier, Geiser Thomas, Joos Zellweger Ladina, Kohler Malcolm, Lüthi-Corridori Giorgia, Maier Sabrina, Miedinger David, Thurnheer Robert, von Garnier Christophe, Leuppi Jörg Daniel
University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland.
Faculty of Medicine, University of Basel, 4056 Basel, Switzerland.
J Clin Med. 2023 Oct 20;12(20):6636. doi: 10.3390/jcm12206636.
(1) Introduction: Chronic obstructive pulmonary disease (COPD) and its associated morbidity and mortality are a global burden on both affected patients and healthcare systems. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues guidelines with the aim of improving COPD management. Previous studies reported significant variability in adherence to these recommendations. The objective of this study was to evaluate Swiss primary practitioners' adherence to the GOLD guidelines for the pharmacological treatment of stable COPD. (2) Methods: We studied patients who were included in the Swiss COPD cohort study, an ongoing prospective study in a primary care setting, between 2015 and 2022. The key inclusion criteria are age ≥ 40 years, FEV1/FVC ratio < 70%, and a smoking history of at least 20 pack-years. Adherence to the GOLD guidelines was assessed per visit and over time. (3) Results: The data of 225 COPD patients (mean age 67 ± 9 years, 64% male) and their respective 1163 visits were analyzed. In 65% of visits (726/1121), treatment was prescribed according to the GOLD guidelines. Non-adherence was most common in GOLD groups A and B (64% and 33%) and mainly consisted of over-treatment (two long-acting bronchodilators in group A (98/195, 50%) and ICS in groups A (21/195, 11%) and B (198/808, 25%)). In group D, the prescriptions conformed with the guidelines in 99% of cases (109/108). Guideline adherence was associated with high symptom load (COPD Assessment Test) (OR 1.04, = 0.002), high number of exacerbations (OR = 2.07, < 0.001), asthma overlap (OR 3.36, = 0.049), and diabetes mellitus (OR 2.82, = 0.045). (4) Conclusion: These results confirm a conflict between the GOLD recommendations and primary practice, mainly concerning over-treatment in GOLD groups A and B. Patients with high symptom load, high exacerbation risk, asthma overlap, and diabetes mellitus are more likely to be treated in conformity with the guidelines. Further research is needed to uncover the reasons for the discrepancies and to design strategies for improvement.
（1）引言：慢性阻塞性肺疾病（COPD）及其相关的发病率和死亡率给受影响的患者和医疗系统带来了全球性负担。慢性阻塞性肺疾病全球倡议（GOLD）发布指南，旨在改善COPD的管理。先前的研究报告称，对这些建议的依从性存在显著差异。本研究的目的是评估瑞士初级医疗从业者对GOLD稳定期COPD药物治疗指南的依从性。（2）方法：我们研究了纳入瑞士COPD队列研究的患者，这是一项在初级医疗环境中正在进行的前瞻性研究，时间跨度为2015年至2022年。主要纳入标准为年龄≥40岁、FEV1/FVC比值<70%以及吸烟史至少20包年。每次就诊及随时间推移评估对GOLD指南的依从性。（3）结果：分析了225例COPD患者（平均年龄67±9岁，64%为男性）及其各自的1163次就诊数据。在65%的就诊中（726/1121），治疗是根据GOLD指南开具的。在GOLD A组和B组中不依从最为常见（分别为64%和33%），主要包括过度治疗（A组中两种长效支气管扩张剂（98/195，50%）以及A组（21/195，11%）和B组（198/808，25%）中的吸入性糖皮质激素（ICS））。在D组中，99%的病例（109/108）处方符合指南。指南依从性与高症状负荷（COPD评估测试）（OR 1.04，P = 0.002）、高急性加重次数（OR = 2.07，P < 0.001）、哮喘重叠（OR 3.36，P = 0.049）和糖尿病（OR 2.82，P = 0.045）相关。（4）结论：这些结果证实了GOLD建议与初级医疗实践之间存在冲突，主要涉及GOLD A组和B组的过度治疗。症状负荷高、急性加重风险高、有哮喘重叠以及患有糖尿病的患者更有可能接受符合指南的治疗。需要进一步研究以揭示差异的原因并设计改进策略。
