Current practices, perceptions and future challenges in the management of moderate to severe COPD: a cross-sectional survey of respiratory consultants in the Republic of Ireland

Abstract

Introduction: Evidence is growing for interventions beyond inhaled therapies in chronic obstructive pulmonary disease (COPD). Clinician attitudes and access to these therapies are crucial to informing COPD care pathways.

Aims: We sought to explore current attitudes, practices, future directions and challenges in the management of moderate to severe COPD among respiratory consultants in the Republic of Ireland (ROI).

Methods: A custom online survey was disseminated by email and text messaging to respiratory consultants in the ROI through the Irish Thoracic Society contact list.

Results: 37 responses were received (24.5% response rate), of which 36 were eligible for inclusion. Completion rate was 97.2% (n=35). Only 9 of 30 respondents (30%) reported sufficient access to pulmonary rehabilitation (PR), and 9 of 29 (31%) to a dedicated COPD multidisciplinary team (MDT). 10 of 29 respondents (34%) infrequently or never consider long-term non-invasive ventilation (LTNIV), despite 21 of 27 (78%) rating the quality of evidence for its benefit in reducing hospitalisations as moderate or high. 16 of 27 respondents (59%) infrequently or never consider lung volume reduction (LVR), despite 22 of 25 (88%) perceiving it to be moderately or highly beneficial towards improving quality of life. There was variable uncertainty regarding the evidence for biologics in COPD, with up to 11 of 24 respondents (46%) uncertain about Tezepelumab. Perceived challenges to integrating biologics into COPD care in the ROI included the absence of national drug reimbursement agreements, lack of dedicated COPD MDTs and administrative burden.

Conclusions: Our study highlights insufficient access to PR and COPD MDTs, variable attitudes towards LTNIV and LVR, and uncertainty around the role of biologics in COPD care. While the modest response rate may limit generalisability, our findings underscore the need to address infrastructural and systemic barriers to optimise care pathways for moderate to severe COPD in the ROI.

Keywords: COPD Pharmacology; Non invasive ventilation; Pulmonary Disease, Chronic Obstructive; Pulmonary Rehabilitation.

Figure 1. Perceived quality of evidence for the benefits of LTNIV in patients with COPD. COPD, chronic obstructive pulmonary disease; GRADE, Grading of Recommendations Assessment, Development and Evaluation; LTNIV, long-term non-invasive ventilation.

Figure 2. Attitudes towards proposed initial limitations on biologic prescribing for COPD. COPD, chronic obstructive pulmonary disease; MDT, multidisciplinary team.

Figure 3. Perception of lung transplantation in COPD subgroups. BODE, body mass, airflow obstriction, dyspnoea, excercise capacity; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; RV, right ventricular.