Abstract and Introduction
Abstract
Background: Despite the evidence-based guidelines promoted by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the overuse of prescription drugs to manage COPD, particularly inhaled corticosteroids (ICS), remains a persistent challenge. In this real-world study, we evaluated how patients with COPD were divided into ABCD groups based on the 2017 GOLD guidelines, determined the rate of adherence to the GOLD treatment recommendations, described the rate of ICS usage, and determined the rate of triple therapy (TT) prescription.
Methods: The charts of 2291 patients diagnosed with COPD were retrospectively analyzed, of which 1438 matched the eligibility criteria.
Results: The average patient age was 69.6 ± 10.9 years; 52% of patients were female. The average COPD assessment test (CAT) score was 18.3 ± 9.1. The ABCD breakdown was as follows: group A 19.5%, group B 64.1%, group C 1.8%, and group D 14.6%. All groups, except group D, showed discordance in COPD treatment relative to the proposed GOLD guidelines. Only 18.9% of group A and 26% of group B were treated in concordance with the guidelines. TT was primarily used in group D (63.3%) and overused in groups A (30.6%) and B (47.8%). ICS was overused in all groups, particularly in groups A (56.2%) and B (67.3%).
Conclusion: Studies from the last decade have consistently revealed a lack of conformity between what physicians prescribe and what GOLD guidelines recommend. The excessive usage of ICS, which continues despite all the associated adverse effects and the attributable costs, is concerning. The awareness of GOLD guidelines among primary care physicians (PCPs) and respiratory specialists needs to be improved.
Introduction
Chronic obstructive pulmonary disease (COPD) is a slowly progressive, inflammatory disease that causes airflow restriction and an irreversible loss of lung function. COPD is becoming increasingly common worldwide due to the rapid aging of the population. Approximately 16 million cases of COPD have been reported in the United States, and COPD is the third leading cause of death in the country.[1] The economic impact of COPD is substantial. The annual per-patient direct medical and hospitalization costs have been reported to be $10,367 and $6852, respectively. A study conducted in 2010 reported that prescription drug costs totaled $472 billion, whereas the total annual US payment for COPD care was $6.6 billion.[2]
Despite evidence-based guidelines published and promoted by the Global Initiative for Obstructive Lung Disease (GOLD) science committee, the overuse of prescription drugs in COPD management, particularly the overuse of inhaled corticosteroids (ICS) at all stages of COPD, remains a persistent challenge. The impact of excessive medication usage on the rising costs of COPD management cannot be overlooked. Although smoking cessation and reducing COPD exacerbations significantly limit the increasing costs, the appropriate use of inhalers in this population would also reduce expenses. Primary care physicians (PCPs) in many countries have been accused of overprescribing ICS.[3–5] Moreover, this prescription pattern is not restricted to PCPs only. Safka et al. conducted their research in a respiratory department of an academic center in Canada. They discovered that 26.8% of the patients in GOLD group A received triple therapy (TT) and that 42.6% in GOLD group B likewise received TT.[6]
The aim of this study was to describe the distribution of COPD in a nonacademic pulmonary specialty practice and to determine the adherence to the COPD GOLD 2017 recommendations.
Objectives
The objectives of this study were to (1) determine how patients with COPD are divided into ABCD groups using the 2017 GOLD guidelines and (2) assess adherence to the 2017 GOLD recommendations.
BMC Pulm Med. 2023;23(216) © 2023 BioMed Central, Ltd.
