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Clinical factors predictive of appropriate treatment in COPD: a community hospital setting

机译：临床因素预测适当治疗的COPD：社区医院环境

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ABSTRACT Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease. The appropriate treatment according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline was 19-60%. However, there are limited data on predictors of appropriate treatment in patients with COPD. This study aimed to evaluate risk factors of appropriate treatment in patients with COPD according to the GOLD guideline in a real-world community setting. Methods: This is a retrospective study conducted at a community hospital. Inclusion criteria were adult patients diagnosed as COPD treated at a COPD clinic. The primary outcome was the appropriate treatment, defined by correct pharmacological treatment by the GOLD guideline according to the ABCD severity assessment. Clinical predictors of appropriate treatment were executed by stepwise multivariate logistic regression analysis. Results: 136 patients with COPD met the study criteria. Of those, 100 patients had inappropriate treatment according to the GOLD guideline. Three factors were independently associated with the appropriate treatment including number of admissions, modified Medical Research Council (mMRC) score, and CAT score. These factors had adjusted odds ratio of 3.11, 2.86, and 1.26, respectively. Causes of inappropriate treatment were unavailability of long-acting muscarinic antagonist (LAMA) (51 patients; 79.69%), treated by inhaled corticosteroid (ICS) alone (12 patients; 18.75%), and treated with only bronchodilator (1 patient; 1.56%). Conclusions: Appropriate COPD patients’ treatment according to the GOLD guideline was 26.47% in community setting. Factors associated with severity of COPD were associated with prescribing appropriate treatments.
机译：摘要背景：慢性阻塞性肺病（COPD）是一种常见的呼吸系统疾病。根据慢性阻塞性肺病（金）指南全球倡议的适当治疗是19-60％。然而，对COPD患者适当治疗的预测因子存在有限的数据。本研究旨在根据真实社区环境中的黄金指南评估适当治疗的危险因素。方法：这是在社区医院进行的回顾性研究。纳入标准是诊断为在COPD诊所治疗的COPD的成年患者。主要结果是根据ABCD严重性评估，通过黄金指南的正确药理处理定义。通过逐步多变量逻辑回归分析执行适当治疗的临床预测因子。结果：136名COPD患者达到了研究标准。其中，100名患者根据黄金指引治疗不当。三个因素与包括招生数量，修改的医学研究委员会（MMRC）评分和猫分数独立相关。这些因素分别调整了3.11,2.86和1.26的赔率比。不适当的治疗的原因是长效的毒蕈碱拮抗剂（喇嘛）（51名患者; 79.69％），通过吸入的皮质类固醇（ICS）（12名患者; 18.75％）治疗，并仅用支气管扩张剂（1例患者; 1.56％）治疗）。结论：根据黄金指南的适当COPD患者治疗是社区环境的26.47％。与COPD严重程度相关的因素与处方适当的治疗有关。

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