Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy

Figures & data

Table 1 General characteristics of subjects

	Mean	Min	Max	Standard deviation
N (M/F)	693 (589/104)
Age, years	71	41	95	9
BMI	28.08	14.69	57.27	5.68
Smoker, former smoker, or never smoker, n (%)	161 (23.3), 438 (63.20), 94 (13.56)
Pack-year	35.15	0.00	210.00	33.93
FEV1%	59.08	16	115	20.13
FVC%	79.08	21	144	21.46
FEV1/FVC	55.84	19.00	70.00	10.81
CAT	15.53	0.00	39.00	8.59
mMRC	2.92	1.00	5.00	1.15
Barthel scale	18.64	6.00	20.00	2.64
<2 exacerbations/year, n (%)	452 (65.30)
≥2 exacerbations/year, n (%)	241 (34.70)
Vaccination influenza virus, n (%)	316 (45.70)
Vaccination pneumococcus, n (%)	164 (23.80)
GOLD classification, n (%)
A	142 (20.60)
B	238 (32.30)
C	41 (5.90)
D	272 (39.20)

Abbreviations: Min, minimum; Max, Maximum; M, male; F, female; BMI, body mass index; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global initiative for chronic Obstructive Lung Disease.

Table 2 Ongoing therapy at the first visit (Figure 1)

Therapy	ALL	Group A*	Group B*	Group C*	Group D*
None, n (%)	69 (9.96)	15 (10.56)	19 (7.98)	5 (12.20)	30 (11.03)
LABA, n (%)	19 (2.74)	6 (4.23)	7 (2.94)	1 (2.44)	1 (1.84)
LAMA, n (%)	124 (17.89)	44 (30.99)	49 (20.59)	9 (21.95)	22 (8.09)
LABA + ICS, n (%)	103 (14.86)	23 (16.20)	47 (19.75)	2 (4.88)	50 (18.38)
LAMA + LABA, n (%)	125 (18.04)	27 (19.01)	28 (11.76)	7 (17.07)	44 (16.18)
ICS + LAMA + LABA, n (%)	228 (32.90)	20 (14.08)	81 (34.03)	17 (41.46)	110 (40.44)
Other therapies, n (%)	25 (3.61)	7 (4.93)	7 (2.94)	0 (0.00)	11 (4.04)
Total, n (%)	693 (100)	142 (100)	238 (100)	41 (100)	272 (100)

Notes:

* GOLD classification.

Abbreviations: GOLD, Global initiative for chronic Obstructive Lung Disease; LABA, long-acting β2-agonists; LAMA, Long-acting muscarinic antagonist; ICS, inhaled corticosteroids.

Figure 1 Ongoing therapy at the first visit.

Abbreviations: LABA, long-acting β2-agonists; LAMA, long-acting muscarinic antagonist; ICS, inhaled corticosteroids.

Table 3 Assessment of the degree of therapeutic appropriateness of the total study population and classified by severity classes in relation to the GOLD 2015 guidelines (Figure 2A–D)

	ALL	Group A*	Group B*	Group C*	Group D*
In line with GL, n (%)	419 (60.46)	57 (40.14)	110 (46.22)	18 (43.9)	234 (86.03)
Not in line with GL, n (%)	205 (29.58)	70 (49.30)	109 (45.80)	18 (43.9)	8 (2.94)
No therapy, n (%)	69 (9.96)	15 (10.56)	19 (7.98)	5 (12.20)	30 (11.03)
Total, n (%)	693 (100)	142 (100)	238 (100)	41 (100)	272 (100)

Notes:

* GOLD classification.

Abbreviations: GL, guideline; GOLD, Global initiative for chronic Obstructive Lung Disease.

Table 4 Online survey results

Online survey	Percentage
The survey showed that ~30% of COPD patients did not follow the therapy suggested by GOLD. Why?
Guidelines far from reality	60
Guidelines are difficult to apply	20
Poor knowledge of the guidelines	20
Why “ABCD” model is difficult to routinely use?
Spirometry is not always feasible	40
mMRC or CAT not always feasible	20
Increased visit time	30
Others	10
Most discrepancies are related to the excessive use of ICS. How do you explain it?
Information received from pharmaceutical companies	50
The corticosteroids are more effective	30
Others	20
Higher percentages of patients are inappropriately treated by triple therapy. Why?
Guarantees better and faster results on the patient’s symptoms	35
Easier to prescribe than double bronchodilation	40
Business issues	15
Others	10
Approximately 11% of patients in Group D did not take any therapy at the time of their first visit.
What are the causes?
The general medical practitioner underestimates the disease	45
Patients underestimate the disease	40
Both	15

Abbreviations: CAT, COPD Assessment Test; GOLD, Global initiative for chronic Obstructive Lung Disease; ICS, inhaled corticosteroids, mMRC, Modified Medical Research Council.

Figure 2 Assessment of the degree of therapeutic appropriateness of the study population classified by severity classes in relation to the GOLD 2015 guidelines.

Abbreviations: GL, guidelines; GOLD, Global initiative for chronic Obstructive Lung Disease.