Management of COPD in Anhui Province: compliance with GOLD guidelines

Abstract

Abstract Background COPD is a major public health concern of global scope, especially in China. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are international and national recommendations to manage COPD. Little is known about level of adherence of COPD management among exacerbated COPD inpatients to GOLD guidelines in China. The current study aimed to compare COPD management (vaccination and treatment of COPD exacerbation) among hospitalized patients in Anhui Province with GOLD guidelines and identify risk factors influencing vaccination coverage and guideline-compliant care. Methods A retrospective clinical audit of medical records was conducted in a hospital in Anhui Province in China, involving 1132 patients hospitalized with exacerbated COPD within 2016-2017. Descriptive analysis was conducted to evaluate compliance to GOLD recommendations (version 2017). Logistic regression was conducted to detect the association between guideline-consistent care and variables. Results Extreme deficiency in the vaccination coverage (0%) was found. Regarding pharmacological management, some adherence to prescribing short-acting bronchodilators timely (43.5%) and prescribing long-acting bronchodilators (55.0%) was observed; nonetheless, only 26.1% of patients received systemic corticosteroids or antibiotics for the recommended duration (<7 days) and only 17.0% did not receive methylxanthines. Age, education level, occupational status and disease severity were independently associated with guideline-consistent treatment. Conclusions The implementation of GOLD recommendations in Anhui Province was unsatisfactory. Interventions to increase the vaccination coverage among COPD patients and to optimize the treatment of COPD exacerbation are imperative, requiring efforts at the hospital and policy levels. Key messages This is the first clinical audit study investigating the COPD management among hospitalized COPD patients in China. The implementation of GOLD recommendations in Anhui Province was unsatisfactory.