Castro Mario, Carney Kevin C, Romanelli Steven M, Dixon Amy L, Abdul Rahman Maryam Q, Aggarwal Kavita, Yawn Barbara P
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Thoracic Medicine & Surgery, Temple University Hospital, Philadelphia, PA, USA.
Chron Respir Dis. 2025 Jan-Dec;22:14799731251346191. doi: 10.1177/14799731251346191. Epub 2025 Jun 5.
ObjectivesTreatment recommendations for chronic obstructive pulmonary disease (COPD) are based on single or combination long-acting bronchodilator therapy (β-agonists [LABAs] or muscarinic receptor antagonists [LAMAs]), with inhaled corticosteroids (ICS) for those at risk of exacerbations. This study evaluated differences in patient characteristics and treatment patterns among US clinicians.MethodsMedical record data for patients with COPD were abstracted via a retrospective cross-sectional survey by pulmonologists, internal/family medicine physicians, nurse practitioners (NPs) and physician assistants (PAs).ResultsData on 700 patients were collected from 175 clinicians: 100 pulmonologists, 45 internal/family medicine physicians, 30 NP/PAs. Respondents classified patients as having Mild (11%), Moderate (51%), or Severe/Very Severe (38%) COPD, with highest perceived disease burden for patients with Severe/Very Severe COPD. Dual therapies were prescribed differently according to clinician type. Internal/family medicine physicians and NP/PAs prescribed LABA/ICS to a significantly higher proportion of patients than pulmonologists, who favored use of dual bronchodilator therapy. Regardless of clinician type, COPD management was complex, with patients starting and transitioning to multiple treatments throughout their care.ConclusionDifferences in COPD treatment patterns exist across US clinicians. Despite current maintenance treatment, COPD had a profound impact on patients, indicating a need for improved therapies for COPD.
目的慢性阻塞性肺疾病（COPD）的治疗建议基于单一或联合长效支气管扩张剂治疗（β受体激动剂[LABAs]或毒蕈碱受体拮抗剂[LAMAs]），对于有急性加重风险的患者使用吸入性糖皮质激素（ICS）。本研究评估了美国临床医生在患者特征和治疗模式上的差异。方法通过肺科医生、内科/家庭医学医生、执业护士（NPs）和医师助理（PAs）进行的回顾性横断面调查，提取COPD患者的病历数据。结果从175名临床医生处收集了700例患者的数据：100名肺科医生、45名内科/家庭医学医生、30名NP/PA。受访者将患者分类为患有轻度（11%）、中度（51%）或重度/极重度（38%）COPD，重度/极重度COPD患者的疾病负担感最高。根据临床医生类型的不同，双重疗法的处方也有所不同。内科/家庭医学医生和NP/PA为患者开具LABA/ICS的比例明显高于肺科医生，肺科医生更倾向于使用双重支气管扩张剂治疗。无论临床医生类型如何，COPD的管理都很复杂，患者在整个治疗过程中开始并转换多种治疗。结论美国临床医生在COPD治疗模式上存在差异。尽管有目前的维持治疗，但COPD对患者有深远影响，表明需要改进COPD的治疗方法。
