A prospective study of maintenance treatment for COPD patients hospitalised for severe exacerbations

To quantify prescription of COPD maintenance treatment in patients hospitalised with an exacerbation.

In this prospective study, COPD patients presenting in a stable state, or with an exacerbation, were recruited from 24 secondary and 15 tertiary care hospitals in China. This analysis concerns patients who were hospitalised. Maintenance treatment was recorded prior to admission, at discharge and 3 months post-discharge.

A total of 615 patients were recruited, 279 from secondary and 336 from tertiary care; mean age 69 years, mean FEV₁ 45 % predicted, mean CAT score 19.1. All had one or more moderate/severe exacerbations in the previous year, mean 1.5 per year, mean hospitalisation 1.4 per year. Only 47 % reported using inhaled maintenance, triple therapy in 28 % and ICS/LABA in 18 %. Maintenance treatment was started in 88 % of patients who were not receiving it, but most patients on a dual therapy (≥69 %) were not stepped up. There was no difference between GOLD group C vs A or D vs B in treatment prescription suggesting that exacerbation history was not considered, however LAMA/LABA was associated with higher mMRC score, ICS/LABA with higher CAT score and triple therapy with GOLD grade.

Despite a high hospitalisation rate, there was under-use of treatment to reduce the risk of exacerbations and failure to step up patients on existing maintenance treatment when they had a severe exacerbation. There was an association between treatment and symptoms and airflow limitation, but physicians did not appear to select treatment based on exacerbation history.