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Abstract
Background
This nationwide study was performed to evaluate the evolution of distributions of patients with COPD according to the 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and to assess the concordance between the prescribed medications and the pharmacological management recommended by the two distinct classification systems in Taiwan.
Subjects and methods
Data were retrospectively retrieved from stable COPD patients in 11 participating hospitals across Taiwan. Patients were grouped according to GOLD 2011 and 2017 guidelines respectively. Definitions of undertreatment and overtreatment were based on the pharmacological recommendations in the individual guidelines.
Results
A total of 1,053 COPD patients were included. The percentages of patients in GOLD 2011 groups A, B, C and D were 18.4%, 40.6%, 6.7% and 34.2%, respectively. When reclassified according to the GOLD 2017, the percentages of group A and B increased to 23.3% and 63.2%, and groups C and D decreased to 1.9% and 11.6%, respectively. Up to 67% of patients in GOLD 2011 groups C and D were reclassified to GOLD 2017 groups A and B. The pharmacological concordance rate was 60.9% for GOLD 2011 and decreased to 44.9% for GOLD 2017. Overtreatment was found in 29.5% of patients according to GOLD 2011 and the rate increased to 46.1% when classified by the GOLD 2017. The major cause of overtreatment was unnecessary inhaled corticosteroids and the main cause of undertreatment was a lack of maintenance long-acting bronchodilators.
Conclusion
The distribution of COPD patients in Taiwan was more uneven with the GOLD 2017 than with the GOLD 2011. A pharmacological discordance to the guidelines was identified. Updated guidelines with reclassification of COPD patients resulted in more discordance between prescribed medications and the guidelines. Physicians should make proper adjustments of the prescriptions according to the updated guidelines to ensure the mostly appropriate treatment for COPD patients.
Supplementary material
The study protocol was reviewed and approved by the individual institutional review board in individual hospitals:
Chang Gung Medical Foundation Institutional Review Board
Taichung Veterans General Hospital Institutional Review Board
E-Da Hospital Institution Review Board
China Medical University and Hospital Research Ethics Committee
Mackay Memorial Hospital Institutional Review Board
National Taiwan University Hospital Research Ethics Committee
Far Eastern Memorial Hospital Research Ethics Review Committee
Cheng-Hsin General Hospital Institutional Review Board
Taipei Tzu-Chi General Hospital Institutional Review Board
Chia-Yi Christian Hospital Institutional Review Board
Acknowledgments
The authors would like to thank the collaborators and members of the Taiwan Obstructive Lung disease (TOLD) study group. We also thank Dr Huey-Wen Liang of National Taiwan University Hospital for her assistance in statistical analysis. Medical editorial assistance and data management of the TOLD study were funded by Novartis Pharmaceuticals Corporation. Data management was assisted by the Formosa Biomedical Technology Corp.
Author contributions
Conception and design: Dr Y-H Tsai; data acquisition, protocol discussion and revision: Dr S-Y Huang, T-M Yang, C-W Tao, S-L Cheng, C-H Lee, P-H Kuo, Y-K Wu, N-H Chen, W-H Hsu, J-Y Hsu, M-S Lin, C-C Wang, and Y-F Wei. Data analysis and interpretation: M-J Hsieh, S-Y Huang, and Y-H Tsai; drafting the article: M-J Hsieh, S-Y Huang; revising the article: M-J Hsieh; final approval of the version to be published: Y-H Tsai. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.