Genga Gino, Alecci Umberto, Vighini Miriam, Stabile Carmen, Cinquepalmi Donato, Grassi Barbara, Pistelli Riccardo
ASUR, Area Vasta 1, Distretto di Fano, Italy.
ASP 5, Messina, Italy.
Int J Chron Obstruct Pulmon Dis. 2025 Sep 4;20:3135-3145. doi: 10.2147/COPD.S517556. eCollection 2025.
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.
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.
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.
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.
ASTER研究描述了意大利全科医生（GP）对慢性阻塞性肺疾病（COPD）的管理，重点关注6个月以上患者的治疗模式和临床结局。
这项多中心前瞻性队列研究纳入了年龄在40 - 80岁、肺功能测定确诊为COPD、支气管扩张剂后FEV≥预测值的50%且前一年发作次数≤1次的患者。符合条件的患者COPD评估测试（CAT）评分≥10，并且根据99号注释之前全科医生的处方限制，他们在入组前的最后3个月内可能仅接受了短效或长效支气管扩张剂或皮质类固醇/长效β受体激动剂ICS/LABA治疗。在入组时、3个月和6个月时对患者进行评估，收集有关治疗、发作、患者报告结局（CAT和mMRC评分）以及肺功能的数据。
总体而言，385例患者入组，344例（89.4%）符合研究标准，其中332例（96.5%）完成了研究。该队列包括轻度至中度COPD患者，主要为男性（61.9%），以及当前/既往吸烟者（91%）。基线时，正在进行的治疗包括长效抗胆碱能药物（LAMA，20.9%）、ICS/LABA（13.7%）和LABA（2.9%）。然而，62.5%的患者未接受治疗。到6个月时，只有10.2%的患者未接受任何治疗，55.4%的患者接受了LABA/LAMA联合治疗。FEV1平均增加了140 mL，mMRC≥2的患者比例从54.9%降至23.5%，CAT平均下降了3.6分，并且在过去6个月中只有13例患者（3.9%）经历了轻度/中度发作。
ASTER研究突出了意大利全科医生对COPD治疗的有效性。早期检测和积极管理，以及定期的治疗处方与肺功能改善、呼吸困难、生活质量提高以及发作发生率降低相关。赋予全科医生诊断和治疗责任，可改善COPD的护理和结局。
