Comparative Study the Impact of COPD Clinic and GP Clinic Treatment on Clinical Outcomes in Real Word Clinical Practice

Abstract

In Thailand, the prevalence of chronic obstructive pulmonary disease (COPD) is rising, with many patients receiving suboptimal or non-guideline-directed treatment. Acute exacerbations of COPD (AECOPD) significantly impact patients’quality of life, increase mortality risk, and contribute to higher healthcare costs. This study aimed to compare the clinical outcomes of COPD patients managed at general practitioner versus specialized COPD clinics. This retrospective, multi-center, cross-sectional observational study included 2,578 patients diagnosed with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Data were collected from both specialized COPD clinics — comprising outpatient departments, emergency rooms and inpatient wards — and from the medical records of general practitioners. The primary endpoints were the frequency of AECOPD events leading to ER visits, hospitalizations, the occurrence of pneumonia, and all-cause mortality. Data were analyzed and summarized using descriptive statistical methods. A total of 2,578 patients were included in the study, with similar demographic and clinical characteristics observed between those managed at COPD clinics (n = 355) and general practitioner (GP) clinics (n = 2,333). At COPD clinics, 93% of patients received long-acting muscarinic antagonist (LAMA) therapy; and 32% were prescribed triple therapy (LAMA + LABA/ICS). In contrast, 92% of patients treated at GP clinics received a combination of long-acting beta-2 agonist and inhaled corticosteroid (LABA/ICS). Patients managed in GP clinics experienced significantly higher rates of acute exacerbations of COPD (AECOPD) — including mild, moderate, and severe episodes — as well as increased incidences of pneumonia and all-cause mortality, compared to those treated at COPD clinics (p<0.05 for all comparisons).