PDF(Pubmed)
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%).
CONCLUSIONS: 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.
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%).
CONCLUSIONS: 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.
摘要：
背景：尽管全球慢性阻塞性肺疾病倡议（GOLD）倡导的循证指南，过度使用处方药来管理COPD，特别是吸入性皮质类固醇（ICS），仍然是一个持续的挑战。在现实世界的研究中,我们根据2017年GOLD指南评估了COPD患者如何被分为ABCD组，确定对GOLD治疗建议的坚持率，描述了ICS的使用率，并确定三联疗法（TT）处方的比例。
方法：对2291例确诊为COPD的患者进行回顾性分析，其中1438项符合资格标准。
结果：患者平均年龄为69.6±10.9岁；52%的患者为女性。COPD评估测试（CAT）平均得分为18.3±9.1。ABCD分解如下：A组19.5%，B组64.1%,C组1.8%,D组14.6%。所有团体,除了D组,显示COPD治疗与拟议的GOLD指南不一致。只有18.9%的A组和26%的B组按照指南进行了治疗。TT主要用于D组（63.3%），过度用于A组（30.6%）和B组（47.8%）。ICS在所有组中都被过度使用，特别是A组（56.2%）和B组（67.3%）。
结论：过去十年的研究一直表明，医生的处方与GOLD指南的建议之间缺乏一致性。ICS的过度使用，尽管存在所有相关的不利影响和可归属成本，是关于的。需要提高初级保健医生（PCP）和呼吸专家对GOLD指南的认识。
方法：对2291例确诊为COPD的患者进行回顾性分析，其中1438项符合资格标准。
结果：患者平均年龄为69.6±10.9岁；52%的患者为女性。COPD评估测试（CAT）平均得分为18.3±9.1。ABCD分解如下：A组19.5%，B组64.1%,C组1.8%,D组14.6%。所有团体,除了D组,显示COPD治疗与拟议的GOLD指南不一致。只有18.9%的A组和26%的B组按照指南进行了治疗。TT主要用于D组（63.3%），过度用于A组（30.6%）和B组（47.8%）。ICS在所有组中都被过度使用，特别是A组（56.2%）和B组（67.3%）。
结论：过去十年的研究一直表明，医生的处方与GOLD指南的建议之间缺乏一致性。ICS的过度使用，尽管存在所有相关的不利影响和可归属成本，是关于的。需要提高初级保健医生（PCP）和呼吸专家对GOLD指南的认识。
