Adherence to Treatment Recommendations for Chronic Obstructive Pulmonary Disease - Results from the Swedish National Airway Register

Abstract

Introduction Swedish guidelines adhere to the international GOLD document regarding management of chronic obstructive pulmonary disease (COPD). Based on data from the Swedish National Airway Register (SNAR) the aim was to evaluate adherence to guidelines of pharmacological treatment of COPD in Swedish primary and secondary care. Methods During a period of 18 months, data on symptoms (CAT, mMRC), lung function, exacerbation history and pharmacological treatment from 15,595 COPD patients from 853 primary care and 125 secondary care clinics were collected from SNAR. Patients with a co-diagnosis of asthma were excluded. Patients were divided into four treatment groups: no pharmacological treatment, short-acting bronchodilators alone, long-acting bronchodilators alone and ICS alone or in combination with bronchodilators. Results Of the patients, 29% were in GOLD group A, 58% in group B, 2% in group C and 11% in group D. CAT score was ≥10 and mMRC score was below 2 in 30.9% of the patients and mMRC score was ≥2 and CAT score <10 in 4.2% of the patients. In 61.4% of the patients, no exacerbation was registered during the last year. Long-acting bronchodilators were prescribed for 78% and ICS for 46% of all patients. In groups A, B, C and D, respectively, 21%, 11%, 11% and 5% did not receive any inhaler therapy; 67%, 81%, 81% and 90% received long-acting bronchodilators; 33%, 46%, 55% and 71% received any ICS containing therapy and 19%, 34%, 39% and 61% received triple therapy. Discussion Data from the SNAR indicate that only a minority of COPD patients were untreated. There was a liberal use of ICS containing drug combinations in subjects who do not have an indication for ICS. A considerable proportion of subjects at high risk of exacerbations did not receive ICS treatment.

Severity distribution and treatment of chronic obstructive pulmonary disease in China: baseline results of an observational study

“…In addition, results from the Taiwan obstructive lung disease (TOLD) study revealed that about one-third of Group A/B patients are prescribed with ICS-containing therapy [41]. In another study based on data from the Swedish National Airway Register(SNAR), about 33% of Group A and 46% of Group B patients were treated with ICS, suggesting a high use of ICS containing therapy [42]. In order to optimize the treatment in patients with COPD, factors such as high blood eosinophil counts or fractional exhaled nitric oxide (FeNO) levels, a past medical history of asthma or allergic rhinitis or findings suggestive of asthma-COPD overlap (ACO) should be considered to identify patients who would benefit from ICS use [10,43,44].…”

Double broncholytic combination of umeclidnium/ vilanterol in COPD therapy: issues of efficacy and safety

“…Важным шагом в упрощении лечения ХОБЛ и улучшении приверженности назначенной терапии является снижение частоты приема доз до минимума, необходимого для поддержания контроля заболевания [19]. Поэтому возможность применять одну дозу один раз в день является важной стратегией для улучшения приверженности к соблюдению лечебного режима [19][20][21][22][23].…”

“…Эти комбинации показали преимущество перед своими монокомпонентами и плацебо по влиянию на объем форсированного выдоха за первую секунду (ОФВ 1 ). При этом эксперты GOLD признают, что сочетание бронхолитиков с разным механизмом действия может повысить эффективность бронходилатации при равном или даже меньшем количестве побочных эффектов [21][22][23]. Предложено несколько объяснений преимущества такой комбинации.…”

Beyond Dual Bronchodilation – Triple Therapy, When and Why

“… 7 Results from the Swedish National Airway Register showed that in GOLD Groups A, and B patients, 19%, and 34%, respectively, received such therapy. 8 …”