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Significant variability in adherence to COPD management recommendations has been reported. We aimed to evaluate real-life COPD pharmacotherapy prescribing patterns and adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy in Switzerland. A questionnaire-based survey was conducted among Swiss general practitioners (GPs) and pulmonologists (PULs) from May 1 to November 30, 2017. Participants were invited to complete a questionnaire on their next 5-10 consecutive patients already receiving a pharmacological treatment for COPD. They were requested to assess dyspnea using the modified Medical Research Council (mMRC) dyspnea scale and to determine whether a treatment adjustment was indicated. Fifty-three PULs and 39 GPs completed questionnaires on 511 COPD patients. Dyspnea with mMRC grade ≥2 was reported in 62.5% of the patients, and 31.9% had had at least two exacerbations (or at least one with hospital admission) in the last 12 months. The vast majority (87.1%) of GOLD A patients were overtreated. In the GOLD B group, 52.2% of prescriptions were concordant with GOLD 2017 recommendations, but 37% of patients were overtreated. Among GOLD C patients, 49.2% received GOLD-adherent treatment and 47.5% were overtreated. In the GOLD D category, 78.8% of the patients received a treatment consistent with recommendations but 15.2% were undertreated. After reassessment of patient status, treatment was modified in 50.3% of the patients. This study confirms that discordance of real-world prescription patterns with international guidance is frequent. Further educational efforts are required to improve adherence to COPD management recommendations.

Zusammenfassung. Die inhalative Therapie ist nach wie vor sowohl bei der COPD als auch beim Asthma eine wichtige Säule der Behandlung. Bei Asthma Patienten stehen primär die inhalativen Kortikosteroide im Vordergrund der Behandlung, während bei COPD Patienten vor allem Bronchodilatatoren eingesetzt werden. In den letzten Jahren änderte sich der Stellenwert der inhalativen Kortikosteroide in der COPD- Therapie immer wieder und aktuell scheinen sie für eine Subgruppe von Patienten wieder mehr an Bedeutung zu gewinnen. Auch bei den inhalativen Therapien wird man sich in Zukunft zunehmend an Biomarkern orientieren. Neu auf dem Markt sind die «Triple Therapien als Fixkombinationen», deren Erfolg sich in den nächsten Jahren zeigen wird. Trotz der grossen Vielfalt an neuen Wirkstoffen, neuen Kombinationen und neuen Inhalationssystemen, ist es wichtig eine gute Übersicht zu behalten und den individuellen Nutzen des Patienten in den Mittelpunkt zu stellen. Ziel ist es aus der Fülle der Angebote, die für den individuellen Patienten geeigneten Präparate in einer für ihn ideal anwendbaren Darreichungsform zu finden. Eine korrekte Inhalationstechnik und Adhärenz zum verschriebenen Therapieplan ist für den Erfolg der inhalativen Therapie entscheidend.

The aims of the survey were to assess first experiences of Swiss COPD patients switching from the disposable to the new reusable Respimat inhaler, and to evaluate physicians´ and patients´ views of the new training material.Patients with a confirmed diagnosis of COPD using a disposable Respimat inhaler for at least three months were included. Patients´ demographics, COPD stage, current treatment, and comorbidities relevant for the handling of the device were assessed. Further, patients were trained on the reusable Respimat by placebo inhaler, patient brochure, video cards/demo films and SMS reminder service. After at least one cartridge change, patients gave comprehensive feedback on their satisfaction with the reusable Respimat and physicians evaluated the need for re-training.235 patients participated in the survey. Of these, 37% suffered from comorbidities restricting the handling of the Respimat. 216 (92%) patients had a better overall satisfaction with the reusable than with the disposable Respimat. Dose counter (86%), monthly preparation (81%) and daily handling (77%) were also assessed as better by most of the patients. In 80% of cases, the user ability was stated as better than for the disposable Respimat. Less than 15% of the patients required further training. Placebo inhaler was the mostly preferred training material by both, physicians (in 86% of the patients) and patients (75%). In patients with comorbidities affecting inhaler handling, overall satisfaction was also better in 86% of the patients.The majority of patients were satisfied with the new reusable Respimat device and proper handling could be attained using the provided training material, even in patients with restricting comorbidities.

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.

Zusammenfassung. Die Myxödemkrise ist eine lebensbedrohliche Komplikation einer nicht oder unzureichend behandelten Hypothyreose (Mortalität 20–25 %). Die Diagnosestellung erfolgt anhand der klassischen klinischen Präsentation verbunden mit dem laborchemischen Nachweis einer Hypothyreose. Neben supportiven Massnahmen und der Behandlung auslösender Faktoren soll die Therapie mit Levothyroxin (ggf. zusätzlich T3) aufgrund der hohen Mortalität rasch erfolgen, bis zum Ausschluss einer Nebennierenrindeninsuffizienz mit begleitender Glukokortikoidsubstitution. Wir präsentieren den Fall einer Patientin mit Myxödemkrise bei Erstdiagnose einer Hypothyreose mit epileptischen Anfällen und schwerer Hyponatriämie.

Clinical trials evaluating the management of acute exacerbations of COPD assess heterogeneous outcomes, often omitting those that are clinically relevant or more important to patients. We have developed a core outcome set, a consensus-based minimum set of important outcomes that we recommend are evaluated in all future clinical trials on exacerbations management, to improve their quality and comparability. COPD exacerbations outcomes were identified through methodological systematic reviews and qualitative interviews with 86 patients from 11 countries globally. The most critical outcomes were prioritised for inclusion in the core outcome set through a two-round Delphi survey completed by 1063 participants (256 patients, 488 health professionals and 319 clinical academics) from 88 countries in five continents. Two global, multi-stakeholder, virtual consensus meetings were conducted to 1) finalise the core outcome set and 2) prioritise a single measurement instrument to be used for evaluating each of the prioritised outcomes. Consensus was informed by rigorous methodological systematic reviews. The views of patients with COPD were accounted for at all stages of the project. Survival, treatment success, breathlessness, quality of life, activities of daily living, the need for a higher level of care, arterial blood gases, disease progression, future exacerbations and hospital admissions, treatment safety and adherence were all included in the core outcome set. Focused methodological research was recommended to further validate and optimise some of the selected measurement instruments. The panel did not consider the prioritised set of outcomes and associated measurement instruments to be burdensome for patients and health professionals to use.

Development of inhaled therapies for COPD and asthma

Rare Complication of a Common Disease: Thyroid and Epileptic Seizures