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CC BY-NC-ND 4.0 · Pneumologie
DOI: 10.1055/a-2414-4197
Originalarbeit

Einsatz von langwirksamen Dreifachkombinationen in der Praxis zur Therapie der chronisch-obstruktiven Lungenerkrankung (COPD) – Die ELETHON-Versorgungsstudie

Use of long-acting triple therapy for chronic obstructive pulmonary disease (COPD) in practice: The ELETHON physiciansʼ survey
Kai-Michael Beeh
1   Institut für Atemwegsforschung GmbH, insaf, Taunusstein, Deutschland
,
Saskia Krüger 
2   Medical Department, Berlin-Chemie AG, Berlin, Deutschland (Ringgold ID: RIN14905)
› Author AffiliationsSupported by: BERLIN-CHEMIE
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Zusammenfassung

Hintergrund Studiendaten weisen auf Versorgungslücken im COPD-Langzeitmanagement mit Diskrepanzen zwischen Leitlinienempfehlungen und deren praktischer Umsetzung hin. Die Gründe sind nur unzureichend bekannt. Ziel der ELETHON-Arztbefragung war die Erfassung ärztlicher Einstellungen und Meinungen zu allgemeinen Konzepten der COPD-Therapie, und im Speziellen zur Initiierung einer inhalativen Dreifachtherapie.

Methodik ELETHON war eine bundesweit durchgeführte Querschnittstudie im ambulanten Sektor bei Hausärzten und Pneumologen unter Verwendung eines strukturierten Fragebogens (17 geschlossene Single- bzw. Multiple-Choice-Fragen) zu den Themen Sekundärprävention, Erfassung von Exazerbationen, Therapieeskalation, Auswahl von inhalativen Dreifachtherapien und Prüfung des Therapieerfolgs bei COPD.

Ergebnisse Fragebögen von n=2028 Hausärzten (HA) und n=371 Pneumologen (FA) wurden ausgewertet. Beide Gruppen weisen der Sekundärprävention bei COPD einen hohen Stellenwert zu (HA/FA 76,4%/90,6%), mit Prüfung von Inhalationstechnik, Impfstatus und adäquater inhalativer Pharmakotherapie als wichtigste Bausteine. Aktivität/Rehabilitation wurde bei Hausärzten deutlich seltener genannt (48,3 vs. 84,5%). Exazerbationen und Symptomverschlechterung gelten als dominierende Parameter für eine Therapieeskalation, werden jedoch mehrheitlich unsystematisch erfasst. Als Schwelle wurden „Hospitalisierung“ und „≥2 ambulante Exazerbationen“ am häufigsten genannt. Eosinophile werden mehrheitlich nicht bestimmt. Bei der Auswahl von Dreifachtherapien werden Festkombinationen bevorzugt, die Verfügbarkeit im gleichen Inhalator wie eine Mono- oder duale Therapie als wichtig betont. Der Therapieerfolg wird anhand von Exazerbationen, Lebensqualität, Symptomen, Lungenfunktion und Bedarfsmedikation bewertet. Der COPD Assessment Test (CAT)-Score kommt nur bei wenigen HA/FA zum Einsatz.

Diskussion und Schlussfolgerung Die ELETHON-Arztbefragung zeigt Lücken im COPD-Management auf. Das Konzept der Sekundärprävention wird als wichtig angesehen, dennoch erfolgt eine Therapieeskalation eher spät. Die Bedeutung des Impfstatus deckt sich nicht mit aktuellen Impfquoten, nicht-pharmakologische Maßnahmen werden unzureichend genutzt. Die Erfassung von Exazerbationen und Symptomatik erfolgt unsystematisch; validierte Fragebögen und Eosinophile haben nur einen untergeordneten Stellenwert. ELETHON liefert wichtige Erkenntnisse zu Barrieren und versteckten Potenzialen im Versorgungsalltag der COPD bei Haus- und Fachärzten in Deutschland.

Abstract

Background Gaps in optimal COPD management have been identified in clinical practice, with discrepancies between guideline recommendations and routine care. The reasons for such discrepancies are incompletely understood. The ELETHON survey aimed to identify physicians’ attitudes towards general concepts of COPD management and, in particular, initiation of inhaled triple therapies.

Method ELETHON was a nationwide cross-sectional survey with general practitioners (GP) and pulmonary specialists (PS) working in the ambulatory outpatient setting in Germany, using a structured 17-item questionnaire (single or multiple choice questions) addressing the topics of secondary prevention, exacerbation detection, strategies for therapy escalation, choice of inhaled triple therapies and evaluation of treatment benefits.

Results Questionnaires filled by n=2028 GPs and n=371 PS were analyzed. In both groups, secondary prevention was deemed important in COPD care (GP/PS 76.4%/90.6%), with inhalation technique, vaccination status, and appropriate inhaled pharmacotherapy as key components. Activity/rehabilitation was rarely mentioned by GPs (48.3% vs. 84.5%). Exacerbations and symptomatic worsening were the main triggers for therapy escalation, but were not recorded in a structured way. “Hospitalization” and “≥2 ambulatory exacerbations” were mentioned most frequently as thresholds. Neither GPs nor PS measured eosinophils in the majority of patients. Fixed triple combinations were preferred, with availability of different treatment steps in the same device as important decision aid. Treatment success was evaluated by exacerbations, quality of life, symptoms, lung function and rescue medication use, while COPD Assessment Test (CAT) score was rarely used by GPs and PS.

Discussion and conclusion The ELETHON survey identified gaps in COPD management in Germany. While secondary prevention is deemed important, escalation of inhaled therapy is undertaken rather late, the reported importance of vaccinations does not match current quota in German COPD patients, and non-pharmacological measures are often unused. Exacerbation and symptom documentation is rather subjective, validated questionnaires and blood eosinophils are of minor relevance. These results provide evidence of barriers and hidden potentials towards optimization of routine ambulatory care for COPD patients in Germany.

Schlüsselwörter

COPD - Dreifachtherapie - Sekundärprävention - Exazerbationen - Therapieeskalation - Versorgungsforschung

Keywords

COPD - triple therapy - secondary prevention - exacerbations - therapy escalation - health services research


Publication History

Received: 22 April 2024

Accepted after revision: 26 August 2024

Article published online:
22 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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