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

Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian, Hongyan Shang, Chen Wang, Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian, Hongyan Shang, Chen Wang

Abstract

Background: Chronic obstructive pulmonary disease (COPD) receives low awareness and is undertreated in China. Understanding the burden and treatment of COPD across the nation is important for improving quality of care for this disease. This study aims to reveal the current situation of COPD severity distribution and management across China.

Methods: Baseline data from REALizing and Improving Management of Stable COPD in China, a multicentre, prospective, longitudinal, observational study, were analysed. Patients diagnosed with COPD as per Global Initiative for Chronic Obstructive Lung Disease 2016 (GOLD 2016) criteria were enrolled from 50 randomly selected hospitals (tertiary, 25; secondary, 25) across six geographical regions. Data were collected in routine clinical settings.

Results: Between 15 December 2017 and 6 August 2020, 5013 patients were enrolled and 4978 included in the full analysis set. Of these, 2459 (49.4%) reported ≥ 1 exacerbation within 12 months prior to study enrolment, with a mean annual rate of 0.9/patient, including 0.2/patient and 0.5/patient leading to emergency room visits and hospitalisation, respectively. Spirometry graded 458 (10.1%), 1886 (41.7%), 1558 (34.5%), and 616 (13.6%) were GOLD stage I-IV, and 536 (11.4%), 1034 (22.0%), 563 (12.0%), and 2566 (54.6%) were classified as GOLD 2016 Group A-D, respectively, without evident regional variations. Inhaled corticosteroids plus long-acting beta2-agonist (ICS/LABA, 1316 [26.4%]), ICS/LABA plus long-acting muscarinic antagonist (ICS/LABA + LAMA, 871 [17.5%]), and LAMA (754 [15.1%]) were prescribed at high rates across all groups and regions. Medications not recommended by GOLD were commonly prescribed (TCM, 578 [11.6%]; others, 951 [19.1%]), and 681 (13.7%) were not given ICS or long-acting bronchodilators.

Conclusions: Disease burden among Chinese COPD outpatients is high. Improved guideline adherence for COPD treatment is needed. Trial registration ClinicalTrials.gov identifier, NCT03131362.

Keywords: COPD management; COPD severity; China; Chronic obstructive pulmonary disease (COPD); Disease burden; Maintenance therapy; Observational study; Outpatients.

Conflict of interest statement

TY, BCai, BCao, JK, FW, YC, WJ, and CW declare that they have no competing interests. HS is an employee of AstraZeneca China.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Severity distribution of COPD across six geographical regions in China. A Distribution of airway limitation stages. B Distribution of Group A‒D assessed as per GOLD 2016. Percentages of patients in each group are indicated. COPD chronic obstructive pulmonary disease, GOLD global initiative for chronic obstructive lung disease
Fig. 2
Fig. 2
Distribution of maintenance medications for COPD. A Distribution of prescribed mono- and combination maintenance therapies for COPD. Mono- or combination therapies with bronchodilators and/or ICS (prescribed for ≥ 0.5% of patients) are shown, with no prohibition of use with mucolytics and other class of medications. B Distribution of medications prescribed in any form for COPD. Percentages and numbers of patients prescribed with each class of medications are indicated. COPD chronic obstructive pulmonary disease, ICS inhaled corticosteroid, LABA long-acting beta2-agonist, LAMA long-acting muscarinic antagonist, SABA short-acting beta2-agonist, SAMA short-acting muscarinic antagonist, TCM traditional Chinese medicine

References

    1. Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study. Lancet Respir Med. 2018;6:421–430.
    1. Wang C, Xu J, Yang L, Xu Y, Zhang X, Bai C, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet. 2018;391:1706–1717.
    1. Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med. 2007;176:753–760.
    1. Collaborators GBDCRD Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5:691–706.
    1. Yin P, Wang H, Vos T, Li Y, Liu S, Liu Y, et al. A subnational analysis of mortality and prevalence of COPD in China from 1990 to 2013: findings from the global burden of disease study 2013. Chest. 2016;150:1269–1280.
    1. WHO COPD fact sheet. ). Accessed 01 Jan 2018.
    1. World Bank data on the total population of China. . Accessed 09 Jul 2020.
    1. Khakban A, Sin DD, FitzGerald JM, McManus BM, Ng R, Hollander Z, et al. The projected epidemic of chronic obstructive pulmonary disease hospitalizations over the next 15 years. A population-based perspective. Am J Respir Crit Care Med. 2017;195:287–291.
    1. GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease updated 2016. 2016. . Accessed 01 Jan 2018.
    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195:557–582.
    1. Chinese Society of Respiratory Disease The guideline for the diagnosis and treatment of chronic obstructive pulmonary disease (2013 revision) Zhonghua Jie He He Hu Xi Za Zhi. 2013;36:255–264.
    1. Cui Y, Dai Z, Luo L, Chen P, Chen Y. Classification and treatment of chronic obstructive pulmonary disease outpatients in China according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017: comparison with GOLD 2014. J Thorac Dis. 2019;11:1303–1315.
    1. Kurmi OP, Davis KJ, Hubert Lam KB, Guo Y, Vaucher J, Bennett D, et al. Patterns and management of chronic obstructive pulmonary disease in urban and rural China: a community-based survey of 25000 adults across 10 regions. BMJ Open Respir Res. 2018;5:e000267.
    1. Fang X, Li S, Gao L, Zhao N, Wang X, Bai C. A short-term educational program improved physicians' adherence to guidelines for COPD and asthma in Shanghai. Clin Transl Med. 2012;1:13.
    1. Ding B, Small M, Bergstrom G, Holmgren U. COPD symptom burden: impact on health care resource utilization, and work and activity impairment. Int J Chron Obstruct Pulmon Dis. 2017;12:677–689.
    1. Yang T, Cai B, Cao B, Kang J, Wen F, Yao W, et al. REALizing and improving management of stable COPD in China: a multi-center, prospective, observational study to realize the current situation of COPD patients in China (REAL)—rationale, study design, and protocol. BMC Pulm Med. 2020 doi: 10.1186/s12890-019-1000-x.
    1. GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017 report. 2017. . Accessed 01 Jan 2018.
    1. Yang Y, Mao J, Ye Z, Li J, Zhao H, Liu Y. Risk factors of chronic obstructive pulmonary disease among adults in Chinese mainland: a systematic review and meta-analysis. Respir Med. 2017;131:158–165.
    1. Lim S, Lam DC, Muttalif AR, Yunus F, Wongtim S, le Lan TT, et al. Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region: the EPIC Asia population-based survey. Asia Pac Fam Med. 2015;14:4.
    1. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370:741–750.
    1. Sun L, Chen Y, Wu R, Lu M, Yao W. Changes in definition lead to changes in the clinical characteristics across COPD categories according to GOLD 2017: a national cross-sectional survey in China. Int J Chron Obstruct Pulmon Dis. 2017;12:3095–3102.
    1. Agusti A, Edwards LD, Celli B, Macnee W, Calverley PM, Mullerova H, et al. Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort. Eur Respir J. 2013;42:636–646.
    1. Lange P, Marott JL, Vestbo J, Olsen KR, Ingebrigtsen TS, Dahl M, et al. Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med. 2012;186:975–981.
    1. Xie X, Zhang T, Wang L, Huang Z. Regional water footprints of potential biofuel production in China. Biotechnol Biofuels. 2017;10:95.
    1. China—peoples republic of biofuels annual China will miss E10 by 2020 goal by wide margin report: Global Agricultural Information Network. USDA Foreign Agricultural Service; 2019. . Accessed 08 Jun 2021.
    1. Li J, Bluemling B, Mol A, Herzfeld T. Stagnating jatropha biofuel development in southwest China: an institutional approach. Sustainability. 2014;6:3192–3212.
    1. Raju S, Brigham EP, Paulin LM, Putcha N, Balasubramanian A, Hansel NN, et al. The burden of rural chronic obstructive pulmonary disease: analyses from the national health and nutrition examination survey. Am J Respir Crit Care Med. 2020;201:488–491.
    1. Gaffney AW, Hawks L, White AC, Woolhandler S, Himmelstein D, Christiani DC, et al. Health care disparities across the urban-rural divide: a national study of individuals with COPD. J Rural Health. 2020 doi: 10.1111/jrh.12525.
    1. Croft JB, Wheaton AG, Liu Y, Xu F, Lu H, Matthews KA, et al. Urban-rural county and state differences in chronic obstructive pulmonary disease—United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67:205–211.
    1. Baptista EA, Dey S, Pal S. Chronic respiratory disease mortality and its associated factors in selected Asian countries: evidence from panel error correction model. BMC Public Health. 2021 doi: 10.1186/s12889-020-10042-7.
    1. Soriano JB, Kendrick PJ, Paulson KR, Gupta V, Abrams EM, Adedoyin RA, et al. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet Respir Med. 2020;8:585–596.
    1. Rhee CK, Chau NQ, Yunus F, Matsunaga K, Perng DW, on behalf the CAotA Management of COPD in Asia: a position statement of the asian pacific society of respirology. Respirology. 2019;24:1018–1025.
    1. Chen H, Zhang L, Zou W, Gao Q, Zhao H. Regional differences of air pollution in China: comparison of clustering analysis and systematic clustering methods of panel data based on gray relational analysis. Air Qual Atmos Health. 2020;13:1257–1269.
    1. Zhu B, Wang Y, Ming J, Chen W, Zhang L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:1353–1364.
    1. Goossens LM, Leimer I, Metzdorf N, Becker K, Rutten-van Molken MP. Does the 2013 GOLD classification improve the ability to predict lung function decline, exacerbations and mortality: a post-hoc analysis of the 4-year UPLIFT trial. BMC Pulm Med. 2014;14:163.
    1. Soriano JB, Lamprecht B, Ramirez AS, Martinez-Camblor P, Kaiser B, Alfageme I, et al. Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2007 and 2011 staging systems: a pooled analysis of individual patient data. Lancet Respir Med. 2015;3:443–450.
    1. Kobayashi S, Hanagama M, Ishida M, Sato H, Ono M, Yamanda S, et al. Clinical characteristics and outcomes in Japanese patients with COPD according to the 2017 GOLD classification: the Ishinomaki COPD Network Registry. Int J Chron Obstruct Pulmon Dis. 2018;13:3947–3955.
    1. Harlander M, Barrecheguren M, Turel M, Miravitlles M. Should patients switched from D to B in the GOLD 2017 classification be discontinued from inhaled corticosteroids? COPD. 2017;14:465–468.
    1. Tudoric N, Koblizek V, Miravitlles M, Valipour A, Milenkovic B, Barczyk A, et al. Gold 2017 on the way to a phenotypic approach? Analysis from the phenotypes of COPD in Central and Eastern Europe (POPE) cohort. Eur Respir J. 2017;2017:49.
    1. Oishi K, Hirano T, Hamada K, Uehara S, Suetake R, Yamaji Y, et al. Characteristics of 2017 GOLD COPD group A: a multicenter cross-sectional cap study in Japan. Int J Chron Obstruct Pulmon Dis. 2018;13:3901–3907.
    1. Wei YF, Kuo PH, Tsai YH, Tao CW, Cheng SL, Lee CH, et al. Factors associated with the prescription of inhaled corticosteroids in GOLD group A and B patients with COPD—subgroup analysis of the Taiwan obstructive lung disease cohort. Int J Chron Obstruct Pulmon Dis. 2015;10:1951–1956.
    1. Larsson K, Ekberg-Jansson A, Stridsman C, Hanno M, Vanfleteren L. Adherence to treatment recommendations for chronic obstructive pulmonary disease—results from the Swedish national airway register. Int J Chron Obstruct Pulmon Dis. 2021;16:909–918.
    1. Vincken S, Sylvia V, Daniel S, Thomas E, Eef V. The role of FeNO in stable COPD patients with eosinophilic airway inflammation. Respir Med. 2021;181:106377.
    1. Wu YK, Su WL, Huang CY, Yang MC, Chen SY, Lan CC. Treatment of chronic obstructive pulmonary disease in patients with different fractional exhaled nitric oxide levels. Medicine (Baltimore) 2018;97:e11922.
    1. Tse HN, Raiteri L, Wong KY, Yee KS, Ng LY, Wai KY, et al. High-dose N-acetylcysteine in stable COPD: the 1-year, double-blind, randomized, placebo-controlled HIACE study. Chest. 2013;144:106–118.
    1. Zheng J-P, Wen F-Q, Bai C-X, Wan H-Y, Kang J, Chen P, et al. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial. Lancet Respir Med. 2014;2:187–194.
    1. Dal Negro RW, Wedzicha JA, Iversen M, Fontana G, Page C, Cicero AF, et al. Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study. Eur Respir J. 2017;50:1700711.
    1. Rand CS. Patient adherence with COPD therapy. Eur Respir Rev. 2005;14:97–101.
    1. Bourbeau J, Bartlett SJ. Patient adherence in COPD. Thorax. 2008;63:831–838.
    1. Gallefoss F. The effects of patient education in COPD in a 1-year follow-up randomised, controlled trial. Patient Educ Couns. 2004;52:259–266.
    1. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD Science Committee report 2019. Eur Respir J. 2019;53:1900164.
    1. National Bureau of Statistics of China. China Statistical Yearbook 2018. . Accessed 16 Mar 2020.
    1. Zhang BP, Xu Y, Zhang H, Luo X, Dong F, Yang T, et al. Survey of current respiratory departments setup in China. Chin J Hosp Admin. 2017;33:829–833.
    1. Stavem K, Sandvik L, Erikssen J. Can global initiative for chronic obstructive lung disease stage 0 provide prognostic information on long-term mortality in men? Chest. 2006;130:318–325.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner