Trends over time in COPD treatment choices by respiratory physicians: An analysis from the COLIBRI-COPD French cohort

Respir Med. 2019 Sep;156:8-14. doi: 10.1016/j.rmed.2019.07.023. Epub 2019 Jul 26.

Abstract

Introduction: Over the last decade, new evidence and many guidelines have been published on COPD pharmacological treatments; prescriptions are often not in accordance with guidelines.

Materials and methods: Trends in physician treatment choices from February 2012 to November 2018 (Feb.2012/Nov.2018) were analyzed using data from COPD patients (spirometry-confirmed diagnosis) included in the COLIBRI-COPD cohort. Inhaled drug treatments (short- or long-acting β2-agonist [SABA or LABA], short- or long-acting anticholinergic [SAMA or LAMA], or corticosteroid [ICS]) were classified into 5 treatment categories: "No initial maintenance treatment (IMT)" (untreated, or only SAMA or SABA); "1 long-acting bronchodilator (LABD)" (LABA or LAMA); "2 LABDs" (LABA + LAMA); "1 LABD + ICS" (LABA or LAMA + ICS); "2 LABDs + ICS" (LABA + LAMA + ICS). For the purpose of the study, 4 periods were defined to achieve balanced samples (T1-T4).

Results: Data from 4537 patients were collected. Over time, 3 major changes were observed: (1) an increase in treatment category "No IMT", mostly for GOLD 1 or GOLD A categories (GOLD A: from 19.1% at T1 to 41.2% at T4); (2) an increase in treatment category "2 LABDs" for GOLD 2 to 4 and GOLD A to D categories (GOLD B: from 15.4% to 29.7%); (3) a decrease in ICS use ("1 LABD + ICS" or "2 LABDs + ICS"), mostly for GOLD 1 to 3 and GOLD A categories (GOLD A, 2 LABDs + ICS: from 35.3% to 11.1%).

Conclusion: Changes over time in therapeutic profiles suggest that new evidence from scientific publications and recommendations may have had a rapid impact on clinical practice.

Keywords: 6/6): COLIBRI; COPD; GOLD; Real-world; Treatment; Trends.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Cohort Studies
  • France
  • Physicians*
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Pulmonary Medicine / trends*