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

Abstract

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 FEV₁ ≥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 beta₂-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.