Adherence to GOLD 2017 Guideline and factors for pharmacological treatment adjustment in Swiss Pulmologists and General Practitioners

Abstract

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) published their new guidelines in 2017. To examine factors associated with treatment adjustment amongst treating physicians. In this questionnaire-based survey, 92 physicians recruited COPD patients. Patients were sorted into the GOLD 2017 treatment gird by exacerbation status and symptoms. A correct treatment for GOLD A was defined as a therapy with a short-acting beta-agonist (SABA), or short-acting muscarinic-antagonist (SAMA), and for GOLD B and C, either a long-acting beta-agonist (LABA), long-acting muscarinic-antagonist (LAMA), or LAMA/LABA combination. The use of inhaled corticosteroid (ICS) was valued as over treatment for GOLD groups A to C. For GOLD D a correct therapy was at least the use of a LAMA/LABA combination. Physicians were asked to adjust treatment after patient assessment. 511 Patients, 223 (43.6%) women, were enrolled. 140 (27.4%) patients were grouped GOLD A, 184 (36.0 %) GOLD B, 61 (11.9%) GOLD C and 118 (23.1%) GOLD D. Overtreatment was found in GOLD A 122 (87.1%) patients with a LABA, LAMA, ICS or combination therapy; in GOLD B 68 (37.0%) patients and in GOLD C 29 (47.5%) patients with ICS. In GOLD D 18 (15.2%) patients were undertreated. Treatment adjustments were done in 236 patients (46.4%). Independent factors for treatment adjustment were having comorbidities (OR3.91; p=0.47), heavy smoking (>41pyrs; OR5.23; p=0.02) and needing rescue medication (OR3.27; p=0.058). Half of the COPD patients were over-treated by ICS. Having comorbidities, heavy smoking and needing rescue medication were factors are leading to a treatment adjustment. Funded by Boehringer