Current Status of the Treatment of COPD in China: A Multicenter Prospective Observational Study

Figures & data

Table 1 Baseline Clinical Characteristics of COPD Patients (N=4796)

Baseline Clinical Characteristics	COPD Patients	Missing Data
Age (years), mean ± SD	64.5±8.9	0 (0)
Male, n (%)	4205 (87.7)	0 (0)
BMI, mean ± SD	22.3±3.6	1074 (22.4)
Educational level, n (%)		635 (13.2)
Primary school or below	1820 (43.7)
Middle school	1571 (37.8)
High school	586 (14.1)
College or above	184 (4.4)
Marital status, n (%)		548 (11.4)
Unmarried	35 (0.8)
Married	4078 (96.0)
Divorce	14 (0.3)
Widowhood	121 (2.8)
Smoking history, n (%)		710 (14.8)
Never smoker	781 (19.1)
Current smoker	1697 (41.5)
Former smoker	1608 (39.4)
Lung function, mean ± SD		976 (20.4)
FEV1, % predicted	47.6±20.2
FEV1/FVC%	48.6±12.7
CAT, mean ± SD	16.3±6.3	586 (12.2)
<10	601 (14.3)
10–20	2406 (57.1)
≥20	1203 (28.6)
mMRC, median (IQR)	2 (1, 3)	586 (12.2)
0 or 1	1326 (31.5)
≥2	2884 (68.5)
Exacerbation history, median (IQR)	1 (0, 2)	771 (16.0)
Moderate	0 (0, 1)
Severe	0 (0, 1)
GOLD stages, n (%)		795 (16.6)
A	321 (8.0)
B	2219 (55.5)
C	60 (1.5)
D	1401 (35.0)
GOLD Classifications, n (%)		976 (20.4)
GOLD 1	292 (7.6)
GOLD 2	1295 (33.9)
GOLD 3	1447 (37.9)
GOLD 4	786 (20.6)

Note: Mean ± SD for numerical variables, median (IQR) for categorical variables.

Abbreviations: FEV₁, forced expiratory volume in 1 second; FEV1/FVC, FEV₁ to forced vital capacity; CAT, COPD Assessment Test; mMRC, modified Medical Research Council Dyspnea Scale.

Figure 1 Patient selection flowchart. In total, data from 8,058 patients with COPD were collected in our study. Among these patients, 4,796 (59.5%) met the inclusion criteria of diagnosis of COPD. There were 3,262 (40.5%) patients excluded, including 1,515 patients were not the first time at the outpatient clinic, 56 were younger than 40 years old, 1520 of co-existing asthma, 119 with bronchiectasis and lung cancer, and 52 data duplicated. In this population, there were 452 of patients with COPD who finished at least 1 year of follow-up.

Note: Data were extracted on October 31, 2019.

Table 2 Description of Inhalation Therapies Used in the Study Population (N=4796)

Therapies, Only Used, n (%)	COPD Patients
Monotherapy
SABA	23 (0.5)
SAMA	20 (0.4)
LABA	1 (0.02)
LAMA	1875 (39.1)
ICS	9 (0.2)
Dual therapy
LABA/ICS	689 (14.4)
LAMA+ICS	7 (0.1)
LAMA/LABA	5 (0.1)
Triple therapy
LAMA+LABA/ICS	1872 (39.0)
Other therapies
LABA/ICS+ICS	1 (0.02)
LABA/ICS+LAMA/LABA	1 (0.02)
SABA+SAMA	1 (0.02)
SABA+ICS	1 (0.02)
SABA or SAMA+LABA/ICS	47 (1.0)
SABA or SAMA+LAMA	83 (1.7)
SAMA+LABA/LAMA	3 (0.06)
SABA or SAMA+LAMA+LABA/ICS	123 (2.6)
SABA+SAMA+ LABA/ICS	1 (0.02)
SABA+SAMA+LAMA+LABA/ICS	3 (0.06)
SAMA +LAMA+LABA/ICS+ICS	1 (0.02)

Notes: LABA/ICS means LABA and ICS are in an inhaler. LAMA/LABA also means they are in an inhaler. “+” means “and”, it was defined to show the all inhalations with different inhalers used simultaneously by patients.

Abbreviations: SABA, short-acting β2-agonist; SAMA, short-acting muscarinic agonist; LAMA, long-acting muscarinic antagonist; LABA, long-acting β2-agonist; ICS, inhaled corticosteroids; NIPPV, non-invasive positive pressure ventilation.

Table 3 Description of Inhalation Therapies Used in Different GOLD-Groups (N=4001)

Therapies, Only Used, n (%)	Group A (n=321)	Group B (n=2219)	Group C (n=60)	Group D (n=1401)	P value
Mono inhaled therapy
SABA	5 (1.6)	7 (0.3)	0 (0)	4 (0.3)	N/A
LABA	0 (0)	0 (0)	0 (0)	1 (0.1)	N/A
SAMA	1 (0.3)	10 (0.4)	0 (0)	4 (0.3)	N/A
LAMA	178 (55.5)	848 (38.2)	32 (53.3)	531 (37.9)	<0.001*
ICS	0 (0)	3 (0.1)	0 (0)	4 (0.3)	N/A
Dual inhaled therapy
LABA/ICS	56 (17.4)	305 (13.7)	10 (16.7)	151 (10.8)	0.004*
LAMA+ICS	1 (0.3)	4 (0.2)	0 (0)	1 (0.1)	N/A
LABA+LAMA	0 (0)	4 (0.2)	0 (0)	1 (0.1)	N/A
Triple inhaled therapy
LAMA+LABA/ICS	60 (18.7)	886 (39.9)	17 (28.3)	621 (44.3)	<0.001*
Other inhaled therapies
SABA+LABA/ICS	6 (1.9)	18 (0.8)	1 (1.7)	7 (0.5)	N/A
SABA or SAMA +LAMA+LABA/ICS	2 (0.6)	60 (2.7)	0 (0)	46 (3.3)	N/A
SABA+LAMA	2 (0.6)	27 (1.2)	0 (0)	15 (1.1)	N/A
SAMA+LAMA	6 (1.9)	15 (0.7)	0 (0)	3 (0.2)	N/A
SAMA+LAMA/LABA	0 (0)	2 (0.1)	0 (0)	1 (0.1)	N/A
SAMA+LABA/ICS	0 (0)	8 (0.4)	0 (0)	2 (0.1)	N/A
SABA+ICS	0 (0)	1 (0.04)	0 (0)	0 (0)	N/A
LABA/ICS+ICS	0 (0)	1 (0.04)	0 (0)	0 (0)	N/A
SABA+SAMA+LAMA+LABA/ICS	0 (0)	1 (0.04)	0 (0)	2 (0.1)	N/A
SAMA+LAMA+LABA/ICS+ICS	0 (0)	1 (0.04)	0 (0)	0 (0)	N/A

Notes: LABA/ICS means LABA and ICS are in an inhaler. LAMA/LABA also means they are in an inhaler. “+” means “and”, it was defined to show the all inhalations with different inhalers used simultaneously by patients. To test for differences of proportion in some variables according to the type of bronchodilators taken, a Chi-square test was used, *P<0.05. N/A means not applicable.

Abbreviations: SABA, short-acting β2-agonist; SAMA, short-acting muscarinic agonist; LAMA, long-acting muscarinic antagonist; LABA, long-acting β2-agonist; ICS, inhaled corticosteroids.

Table 4 Description of Inhalation Therapies Used in Different GOLD Classifications Based on Airflow Limitation (N=3820)

Therapies, Only Used, n (%)	GOLD 1 (n=292)	GOLD 2 (n=1295)	GOLD 3 (n=1447)	GOLD 4 (n=786)	P value
Monotherapy
SABA	2 (0.7)	14 (1.1)	1 (0.1)	5 (0.6)	N/A
LABA	0 (0)	0 (0)	1 (0.1)	0 (0)	N/A
SAMA	9 (3.1)	3 (0.2)	2 (0.1)	2 (0.3)	N/A
LAMA	205 (70.2)	672 (51.9)	448 (31.0)	157 (20.0)	<0.001*
ICS	0 (0)	1 (0.1)	1 (0.1)	5 (0.6)	N/A
Dual therapy
LABA/ICS	36 (12.3)	207 (16.0)	221 (15.3)	94 (12.0)	0.044*
LAMA+ICS	0 (0)	2 (0.2)	0 (0)	0 (0)	N/A
LABA/LAMA	0 (0)	3 (0.2)	2 (0.1)	0 (0)	N/A
Triple therapy
LAMA+LABA/ICS	20 (6.8)	299 (23.1)	684 (47.3)	477 (60.7)	<0.001*
Other therapies
SABA+LABA/ICS	2 (0.7)	14 (1.1)	0 (0)	5 (0.6)	N/A
SABA or SAMA +LAMA+LABA/ICS	0 (0)	23 (1.8)	50 (3.5)	29 (3.7)	N/A
SABA+SAMA	0 (0)	0 (0)	1 (0.1)	0 (0)	N/A
SABA+LAMA	3 (1.0)	23 (1.8)	13 (0.9)	5 (0.6)	N/A
SAMA+LAMA	10 (3.4)	11 (0.8)	3 (0.2)	0 (0)	N/A
SAMA+LAMA/LABA	0 (0)	1 (0.1)	2 (0.1)	0 (0)	N/A
SAMA+LABA/ICS	0 (0)	8 (0.6)	10 (0.7)	1 (0.1)	N/A
SABA+ICS	0 (0)	0 (0)	1 (0.1)	0 (0)	N/A
LABA/ICS+ICS	0 (0)	0 (0)	1 (0.1)	0 (0)	N/A
SAMA+LAMA+LABA/ICS+ ICS	0 (0)	0 (0)	0 (0)	1 (0.1)	N/A

Notes: LABA/ICS means LABA and ICS are in an inhaler. LAMA/LABA also means they are in an inhaler. “+” means “and”, it was defined to show the all inhalations with different inhalers used simultaneously by patients. To test for differences of proportion in some variables according to the type of bronchodilators taken, a Chi-square test was used, *P<0.05. N/A means not applicable.

Abbreviations: GOLD, Global Initiative for COPD; SABA, short-acting β2-agonist; SAMA, short-acting muscarinic agonist; LAMA, long-acting muscarinic antagonist; LABA, long-acting β2-agonist; ICS, inhaled corticosteroids.

Table 5 Baseline Clinical Characteristics of COPD Patients Finished 1 Year of Follow-Up Visit (N=452)

Baseline Clinical Characteristics	One Year of Follow-Up
Age (years), mean ± SD	61.2±7.9
Male, n (%)	432 (95.6)
BMI, mean ± SD	22.5±3.3
Educational level, n (%)
Primary school or below	195 (43.1)
Middle school	179 (39.6)
High school	56 (12.4)
College or above	22 (4.9)
Marital status, n (%)
Unmarried	5 (1.1)
Married	435 (96.2)
Divorce	4 (0.9)
Widowhood	8 (1.8)
Smoking history
Never smoker	81 (18.0)
Former smoker	229 (50.7)
Current smoker	141 (31.3)
Lung function, mean ± SD
FEV1, % predicted	47.3±19.4
FEV1/FVC%	49.6±12.0
CAT, mean ± SD	15.0±6.2
mMRC, median (IQR)	2 (1, 3)

Note: Mean ± SD for numerical variables, median (IQR) for categorical variables.

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index; GOLD, Global Initiative for COPD; CAT, COPD Assessment Test; mMRC, modified Medical Research Council Dyspnea Scale.

Table 6 Lung Function, Symptoms and Inhalation Therapy at Baseline and After 12 Months (N=452)

Variates	COPD Patients		P value
	Baseline	Follow-Up
Exacerbations, median (IQR)	n=420	n=452
Moderate	1 (0, 2)	2 (2, 2)	<0.001*
Severe	0 (0, 0)	2 (1, 2)	<0.001*
Lung function, mean ± SD
Pre-bronchodilator	n=358	n=358
FEV1, % predicted	48.0±19.3	47.7±19.0	0.732
FEV1/FVC%	50.0±11.9	48.7±12.0	0.001*
CAT, mean ± SD	n=427	n=427
	15.0±6.2	14.5±6.7	0.094
mMRC, median (IQR)	n=427	n=427
	2 (1, 3)	2 (2, 3)	<0.001*
Inhalants, total, n (%)	n=387	n=308
Monotherapy
SABA	0 (0)	0 (0)	N/A
LABA	0 (0)	0 (0)	N/A
SAMA	1 (0.3)	1 (0.3)	N/A
LAMA	187 (48.3)	108 (35.1)	<0.001*
ICS	0 (0)	0 (0)	N/A
Dual therapy
LABA/ICS	49 (12.7)	45 (14.6)	0.455
LAMA+ICS	0 (0)	1 (0.3)
LAMA/LABA	0 (0)	1(0.3)
Triple therapy
LAMA+LABA/ICS	138 (35.7)	140 (45.5)	0.009*
Other therapies
SABA+LABA/ICS	2 (0.5)	1(0.3)	N/A
SABA+LAMA	2 (0.5)	2 (0.6)	N/A
SABA or SAMA +LAMA+LABA/ICS	8 (2.1)	7 (2.2)	0.889

Notes: LABA/ICS means LABA and ICS are in an inhaler. LAMA/LABA also means they are in an inhaler. “+” means “and”, it was defined to show the all inhalations with different inhalers used simultaneously by patients; Continuous variables were statistically compared using paired t-test, categorical variables were compared using Wilcoxon matched-pairs signed-rank test; Chi-square test or Fisher’s test was used to compare the proportion between the two groups, *P<0.05; N/A means not applicable.

Abbreviations: CAT, COPD Assessment Test; mMRC, modified Medical Research Council Dyspnea Scale; SABA, short-acting β2-agonist; SAMA, short-acting muscarinic agonist; LAMA, long-acting muscarinic antagonist; LABA, long-acting β2-agonist; ICS, inhaled corticosteroids.