Guideline-Recommended, Nonpharmacologic Interventions Not Often Used in COPD

Relatively low levels of utilization of guideline-recommended, nonpharmacologic interventions for chronic obstructive pulmonary disease (COPD), with the exception of influenza vaccination, have been reported in Germany.

A prospective, observational, multicenter, cohort study — the COSYCONET (German COPD and Systemic Consequences-Comorbidities Network) — was conducted, and the results were published in Respiratory Medicine. 

Investigators sought to provide data on the use of recommended, COPD-specific, nonpharmacologic interventions in patients with COPD, according to sex and Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups A through D. A secondary objective of the current study was to recognize determinants of use, and to explore the association between a physician’s recommendation and the use of a particular intervention.

In the COSYCONET cohort, a total of 2741 patients were included at baseline between 2010 and 2013 across Germany. The participants were reexamined after 6, 18, and 36 months, with ongoing follow-up visits. To qualify for study inclusion, participants needed to be aged ≥40 years and to have physician-diagnosed COPD.

Based on self-reports, the use of interventions (ie, smoking cessation, influenza vaccination, pulmonary rehabilitation, physiotherapy, sports programs, and patient education) and recommendations for their use were evaluated in 1410 individuals with COPD. The utilization was evaluated according to the severity of COPD and an individual’s sex. Potential determinants of use of interventions included demographic variables and disease characteristics.

The majority of the participants (59%) were men, and the mean patient age at baseline was 64.5 years. Being a current smoker was reported by 20% of men and by 26% of women. Although pulmonary function values and GOLD groups did not differ between the sexes, women reported significantly higher levels of dyspnea (modified Medical Research Council dyspnea scale of ≥2). Moreover, women were more likely than men to have experienced a COPD exacerbation in the past 12 months.

Influenza vaccination in the prior autumn/winter season was reported by 73% of the participants. Approximately 19% of patients were currently participating in a reimbursed sports program and 10% received physiotherapy. Additionally, 38% of individuals were enrolled in an educational program, and 34% had participated in an outpatient or inpatient rehabilitation program. Furthermore, in 553 current or former smokers, 24% had taken part in a smoking cessation program.

Women demonstrated significantly higher utilization rates (P <.05) than men for all of the interventions aside from influenza vaccination. Smoking was a predictor for not having received a recommendation for use of an intervention and was also significantly associated with a decreased likelihood of utilization of an intervention. A correlation was reported between a recommendation to utilize an intervention and the actual use of an intervention. The largest difference with respect to proportions was reported for smoking cessation programs (19.0% use in men vs 30.0% use in women; P =.0025).

Regarding the use of pharmacologic interventions across the 4 GOLD groups, patients in GOLD group A were the least likely to have received all of the interventions, whereas utilization of the interventions was reported to be the highest among those in GOLD group D. Additionally, 89% of patients who noted that a physician had recommended their taking part in an educational program reported having actually used such a program, whereas 13% reported utilization without a prior recommendation.

The investigators concluded that additional studies on the subject are warranted to explore cost-efficient methods to inform and encourage patients to commence the use of guideline-recommended, nonpharmacologic interventions for the management of COPD.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Lutter JI, Lukas M, Larissa Schwarzkopf L, et al; for the COSYCONET Study Group. Utilization and determinants of use of non-pharmacological interventions in COPD: results of the COSYCONET cohort [published online July 12, 2020]. Resp Med. doi:10.1016/j.rmed.2020.106087