Understanding Chronic Obstructive Pulmonary Disease Management and Treatment Patterns in General Medicine: Results From the ASTER Study in Italy.

PURPOSE

The ASTER study described the management of chronic obstructive pulmonary disease (COPD) by general practitioners (GPs) in Italy, focusing on the treatment patterns and clinical outcomes of patients over 6 months.

PATIENTS AND METHODS

This multicenter prospective cohort study included patients aged 40-80 years with spirometry-confirmed COPD, post-bronchodilator FEV ≥50% of predicted value, and ≤1 exacerbation in the previous year. Eligible patients had a COPD assessment test (CAT) score of ≥10 and, according to the prescription limits for GPs before Note 99, they could have been treated in the last 3 months before enrollment exclusively with a short or long acting bronchodilator or an corticosteroid/long-acting beta-agonist ICS/LABA. Patients were evaluated at enrollment, 3 months, and 6 months, with data collected on treatment, exacerbations, patient-reported outcomes (CAT and mMRC scores), and lung function.

RESULTS

Overall, 385 patients were enrolled, and 344 (89.4%) met the study criteria, of which 332 (96.5%) completed the study. The cohort included patients with mild to moderate COPD, predominantly males (61.9%), and current/former smokers (91%). At baseline, ongoing treatments included LAMA (20.9%), ICS/LABA (13.7%), and LABA (2.9%). However, 62.5% of patients were not treated. By 6 months, only 10.2% of patients were not receiving any treatment and 55.4% were treated with a LABA/LAMA combination. FEV1 showed a mean increase of 140 mL, mMRC ≥ 2 decreased from 54.9% to 23.5%, CAT exhibited a 3.6 point mean decrease, and only 13 patients (3.9%) experienced mild/moderate exacerbations in the last 6 months.

CONCLUSION

ASTER study highlights the effectiveness of COPD treatment by GPs in Italy. Early detection and proactive management, along with a regular treatment prescription was associated with improved lung function, dyspnea, quality of life, and a reduction in the incidence of exacerbations. Empowering GPs with diagnostic and therapeutic responsibilities, improves care and outcomes of COPD.