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

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.

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

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