REALizing and improving management of stable COPD in China: results of a multicentre, prospective, observational study (REAL).

IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM
Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian, Chen Wang
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引用次数: 0

Abstract

Background: Chronic obstructive pulmonary disease (COPD) management in China is far from adequate; underdiagnosis and undertreatment are major barriers to optimal care and improved patient outcomes.

Objective: To generate reliable information on COPD management, outcomes, treatment patterns and adherence, and disease knowledge in China in a real-world setting.

Design: A 52-week multicentre, prospective, observational study.

Methods: Outpatients (⩾40 years old) diagnosed with COPD were enrolled from 50 secondary and tertiary hospitals across six geographical regions. Data were collected in routine clinical practice.

Results: Between June 2017 and January 2019, 5013 patients were enrolled and 4978 included in the analysis. Mean [standard deviation (SD)] age was 66.2 (8.9) years, 79.5% were male and 90% had moderate-to-very-severe airflow limitation. Annual rates of overall and severe exacerbation were 0.56 and 0.31, respectively. During 1 year, 1536 (30.8%) patients experienced ⩾1 exacerbation and 960 (19.3%) patients had ⩾1 exacerbation requiring hospitalization/emergency visit. Mean (SD) COPD assessment test score was 14.6 (7.6) at baseline and 10.6 (6.8) at follow-up; however, 42-55% of patients had persistent dyspnoea, chest tightness and wheezing at 1 year. The most prescribed treatments were inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) (36.0%), ICS/LABA + long-acting muscarinic antagonist (LAMA) (17.7%) and LAMA monotherapy (15.3%). Among patients with high exacerbation risk (GOLD Groups C and D), 10.1% and 13.1%, respectively, did not receive any long-acting inhalers; only 53.8% and 63.6% of Group C and D patients with ⩾1 exacerbation during follow-up were prescribed ICS-containing therapy, respectively. Mean (SD) adherence for long-acting inhalers was 59.0% (34.3%). Mean (SD) score for the COPD questionnaire was 6.7 (2.4).

Conclusion: These results indicate a high burden of severe exacerbations and symptoms in Chinese outpatients with COPD, and low adherence with treatment guidelines, highlighting the need for more effective management nationwide.

Registration: The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362).

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在中国实现和改善稳定期COPD的管理:一项多中心、前瞻性、观察性研究(REAL)的结果。
背景:慢性阻塞性肺疾病(COPD)在中国的管理还远远不够;诊断不足和治疗不足是实现最佳护理和改善患者预后的主要障碍。目的:在现实世界的背景下,获得中国COPD管理、结局、治疗模式和依从性以及疾病知识的可靠信息。设计:一项52周的多中心前瞻性观察性研究。方法:从六个地理区域的50家二级和三级医院招募了诊断为COPD的门诊患者(大于或等于40岁)。资料收集于常规临床实践中。结果:2017年6月至2019年1月,5013例患者入组,4978例纳入分析。平均[标准差(SD)]年龄为66.2(8.9)岁,79.5%为男性,90%有中度至极严重的气流限制。年总体恶化率和严重恶化率分别为0.56和0.31。在1年期间,1536名(30.8%)患者经历了大于或等于1的恶化,960名(19.3%)患者经历了大于或等于1的恶化,需要住院/急诊。COPD评估测试的平均评分(SD)基线时为14.6分(7.6分),随访时为10.6分(6.8分);然而,42-55%的患者在1年时出现持续的呼吸困难、胸闷和喘息。处方最多的治疗方法是吸入皮质类固醇(ICS)/长效β2激动剂(LABA)(36.0%)、ICS/LABA +长效毒蕈碱拮抗剂(LAMA)(17.7%)和LAMA单药治疗(15.3%)。在高恶化风险患者(GOLD组C和D)中,分别有10.1%和13.1%未接受任何长效吸入器;在随访期间,只有53.8%和63.6%的小于或等于1恶化的C组和D组患者分别接受了含有ics的治疗。长效吸入器的平均(SD)依从性为59.0%(34.3%)。COPD问卷的平均(SD)评分为6.7分(2.4分)。结论:这些结果表明,中国慢性阻塞性肺病门诊患者严重恶化和症状的负担较高,并且对治疗指南的依从性较低,因此需要在全国范围内进行更有效的管理。注册:该试验于2017年3月20日注册(ClinicalTrials.gov标识符:NCT03131362)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
0.00%
发文量
57
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Respiratory Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of respiratory disease.
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