Treatment choices in COPD: guideline variance may be driven by patients’ phenotype

There are an increasing number of maintenance therapies available for COPD. Adherence to Global initiative on chronic Obstructive Lung Disease (GOLD) guidelines by physicians has been shown to be poor but it is not clear if this variance can be explained by the clinical characteristics of the patient. Roche and colleagues (Respiratory Research 2019;20:189) investigated how clinical characteristics may influence physician choice of COPD treatment using an observational cohort design. The French COLIBRI project database was used to identify 1171 COPD patients with complete datasets from a total of 4160 available records. Patient’s maintenance COPD treatment was divided into A: no COPD treatment or short-acting bronchodilator(s) only; B: one long-acting bronchodilator (long-acting β agonist; LABA or long-acting muscarinic antagonist; LAMA); C: LABA+LAMA; D: LABA or LAMA+inhaled corticosteroid (ICS); E: triple therapy (LABA+LAMA+ICS). There were discrepancies in treatment choice with surprisingly few patients prescribed a short-acting bronchodilator (34% of the total cohort: 15.4% of GOLD A, 29.5% of GOLD B, 17.9% of GOLD C, 51.4% of GOLD D), and 15% of patients having no inhaled treatments (short-acting or long-acting). ICSs were given in 24.5% of GOLD …