Predictors for treatment changes in COPD – A Swiss Cohort Study

Introduction: Chronic obstructive pulmonary disease (COPD) is a widely spread chronic disease. In Switzerland, it is estimated that 400’000 patients suffer from COPD and 65million worldwide. Aims and Objectives: The Swiss COPD Cohort Study (SCCS) was established in 2006 to asses COPD management in primary care. To date little is known about factors associated with changes in COPD therapy. Therefore, we evaluated determinants for therapy change. We hypothesized that exacerbations and a high burden of symptoms would be predictive. Method: The SCCS is an ongoing questionnaire-based study. General practitioners recruited patients with a spirometrically diagnosed COPD. Every 6 months information about symptoms, exacerbations, treatment and comorbidities were collected. Data of patients included from 2015-2019 were used and screened for therapy change. A logistic mixed model was performed to detect predictors. Results: 195 patients with 690 visits were included. The mean age was 68.1 (37-90) years, 35.4% were female, the mean FEV1 was 60.9 (±18.13) and most patients had COPD GOLD A or B (81.5%). 69% of the visits were without therapy changes. In 31%, a treatment adjustment was detected, whereof 34% presented a step-up in therapy, 32% a step-down and 34% a step-up and step-down in one visit. Exacerbation, GOLD stage C, D and severe airway obstruction GOLD 3-4 were associated with treatment changes. If comorbidities were present, therapy changes were less likely. Conclusion: This analysis demonstrates that in most visits there were no therapy changes. If adjustments were made, they were linked to exacerbation, GOLD stage and severity of airflow limitation. Comorbidities showed a negative association with therapy changes.