Patterns and Adherence to GOLD-Recommended Inhaled Therapy in Chronic Obstructive Pulmonary Disease (COPD) Patients with Acute Exacerbation History in Primary Care in China

Hongjing Pei,1 Yujing Su,1 Guanning Jing,1,2 Qiaoli Su,3 Jiao Xu,4 Xue Jin,1 Jingyu Hao,1 Jiapei Xu,1 Jianhua Chen,1 Xueying Li,5 Jing Ma,6 Ying Wang,1 Jingyi Ye,1 Mi Yao,1,2 Chunhua Chi1,2,7,8 1Department of General Practice, Peking University First Hospital, Beijing, People’s Republic of China; 2Health Management Center, Peking University First Hospital, Beijing, People’s Republic of China; 3Department of General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 4West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 5Department of Medical Statistics, Peking University First Hospital, Beijing, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 7General Practice Development and Research Center, Peking University Health Science Center, Beijing, People’s Republic of China; 8Center for Primary Healthcare Big Data, National Institute of Health Data Science at Peking University, Beijing, People’s Republic of ChinaCorrespondence: Mi Yao, Department of General Practice, Peking University First Hospital, 8 Xishiku Road Xicheng District, Beijing, 100034, People’s Republic of China, Email [email protected] Chunhua Chi, Department of General Practice, Peking University First Hospital, 8 Xishiku Road Xicheng District, Beijing, 100034, People’s Republic of China, Email [email protected]: The standardized treatment of chronic obstructive pulmonary disease (COPD) in primary care settings in China remains suboptimal. This study aims to investigate the inhaled medication patterns among COPD patients with a history of acute exacerbations in primary care settings and to analyze the prescription adherence of inhaled medication for those COPD patients to the Global Strategy for Prevention, Diagnosis and Management of COPD (2023).Patients and methods: A cross-sectional analysis of the baseline data from a multicenter, prospective cohort of COPD participants was performed. Patients diagnosed with COPD and had at least one mild, moderate or severe acute exacerbation in the previous 12 months were enrolled from 12 primary care clinics in two cities in China (Beijing and Chengdu). Sociodemographic information, symptoms and quality of life, pulmonary function results and inhaled therapy types were collected. Inhaled therapy distributions and adherence to GOLD recommendations were described and visualized, proportions were summarized descriptively.Results: Six hundred and forty-six participants were included in the analysis. 82.7% of the patients were men, mean age 68.7 years. Group A, B, and E accounted for 12.1%, 13.7%, and 66.1%, respectively. 33.4% of the participants received No inhaled therapy. The most frequently used regimen was LABA/ICS (29.9%), followed by LABA/LAMA/ICS (26.0%). Adherence to GOLD strategy was the lowest in group B (4.2%), highest in group E (33.5%). Based on GOLD 2023 recommendation, 35.3% of the group A participants and 32.3% of the group B participants showed inhaled medication underuse, whereas 55.3% and 63.5% showed inhaled medication overuse in group A and B, respectively.Conclusion: Among the COPD patients with a history of acute exacerbations at primary care, prescribing frequently diverged from GOLD 2023 recommendations, characterized by high rates of No inhaled therapy and widespread use of ICS-containing regimens in groups A and B, necessitating improved prescription guideline adherence in the future to facilitate the implementation of standardized COPD management.Keywords: chronic obstructive pulmonary disease, primary care cohort, inhaled therapy, prescription patterns, guideline adherence