A Real-World Evaluation of Therapeutic Inertia in Patients with Severe Uncontrolled Chronic Obstructive Pulmonary...

Therapeutic inertia (TI) defined as failure to escalate or initiate adequate therapy when treatment goals are not met, contributes to poor outcome in patients with chronic obstructive pulmonary disease (COPD). This real-world study aimed to investigate TI and the discrepancy between disease control assessed by physicians' perception and objective methods.

This was a post hoc analysis of data of 4801 patients with severe COPD (FEV₁ < 50% predicted) included in an observational cross-sectional multicenter nationwide study conducted in Spain. Controlled vs. uncontrolled disease was considered according to COPD assessment test (CAT) score ≤ or > 16 and absence or presence of at least one exacerbation in the past 3 months. A 5-point Likert scale (very poor/poor; satisfactory/good/very good) was used to assess COPD control perceived by physicians and patients' satisfaction with treatment.

Uncontrolled COPD was present in 3479 of 4801 patients (72.5%) and controlled COPD in 1322 (27.5%). Among patients with uncontrolled COPD, no treatment adjustments were made in 1519, with a rate of TI of 43.7%. In the multivariate analysis, former smokers, lower exacerbations history, white sputum, lower degree of dyspnea, higher adherence to inhaled therapy, use of dual/triple inhaled medications, absence of SABA use, secondary healthcare level, and patient's satisfaction with treatment were significantly associated with TI. Physicians perceived controlled disease in 2373 patients with uncontrolled COPD, with a discordance rate of 68.2%. Among patients with controlled COPD, the discordant rate was 6.3%. The most influential variables associated with controlled COPD rated by physicians were patients' satisfaction with treatment, no exacerbations in the past year, triple therapy, and ex-smoking status.

The high rate of TI and the gap between actual COPD control and physicians' perceptions, highlights the urgent need to systematize and standardize the follow-up of patients with severe COPD in daily practice.