Treatment Decisions for Stable Chronic Obstructive Pulmonary Disease in China: An Observational Cross-Sectional Survey Based on Multivariate Discrete Choice Modeling.

PURPOSE: To understand the current situation of respiratory and community physicians in China regarding the initial treatments for patients with chronic obstructive pulmonary disease (COPD).

PATIENTS AND METHODS: A multivariate discrete choice model was applied to simulate patients with stable COPD, and an online questionnaire was randomly provided to respiratory physicians and community physicians. The questionnaire responses and medications prescribed to the simulated patients by the doctors in the different groups were analyzed and compared.

RESULTS: (1) This study surveyed 109 doctors who made prescription decisions for 872 simulated COPD patients. (2) The results of the questionnaire revealed that the percentages of LAMA, LAMA/LABA and triple therapies that could be prescribed in community health care centers were 40.6%, 25%, and 34.4%, respectively. More than 60% of the physicians in the CHC and SH groups prescribed ICS/LABA as an initial regimen for maintenance therapy. (3) Triple therapy accounted for the highest proportion of prescriptions at 49%, followed by dual bronchodilator therapy (29.6%), whereas LAMA monotherapy represented the smallest share, with only 4.9% of prescriptions. Notably, ICS/LABA combination therapy represented a clinically relevant proportion of prescriptions (14.3%). A total of 58.9% of the 170 simulated COPD patients without asthma in the current study were prescribed triple therapy by their physicians. Approximately 60% of the COPD patients in Groups A and B were prescribed triple therapy as an initial treatment regimen, despite blood EOS counts of 100-300 cells/µL in both groups.

CONCLUSION: Although most respiratory physicians follow guidelines for the choice of initial therapy for COPD, there are still irregularities in the use of triple therapy. A clinically relevant percentage of physicians, especially community physicians, selected ICS+LABA as the initial treatment choice. These practice irregularities should be the focus of future guidelines for promotion and education.