ArticleThe Lancet regional health. Europe2026
GOLD-concordant inhaled maintenance therapy at hospital discharge after hospitalisation for severe COPD exacerbation: a multicentre retrospective observational study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity, with frequent exacerbations resulting in hospitalizations, increased healthcare burdens, and mortality. The GOLD report emphasizes dual or triple inhaler therapy for high-risk (GOLD group E) patients, yet real-world guideline adherence during hospitalization remains unclear. This study aimed to evaluate concordance with GOLD-recommended maintenance inhaler therapy at hospital discharge in patients with severe exacerbations of COPD and to identify factors associated with treatment rates. Methods: We conducted a retrospective, multicentre, observational study of 3928 COPD inpatients across 85 hospitals within the German Helios group (January 2022-September 2024). The primary outcome was the proportion of patients discharged on GOLD-concordant inhaler therapy, defined as dual long-acting bronchodilation (LABA/LAMA), or triple therapy (LABA/LAMA/ICS) in patients with eosinophils ≥300/μL or high exacerbation risk. Secondary outcomes included diagnostic procedures, pharmacological management, hospital characteristics, in-hospital outcomes and predictors of guideline-concordant prescribing assessed using multivariable logistic regression models. Findings: The mean age of the cohort was 70.1 years (SD 10.1), 45% (n = 1784) were female, 75% (n = 2952) had cardiovascular comorbidities and 45% were treated on pneumology wards. Eosinophil counts were measured in 49% (n = 1895) of patients. During hospitalisation, 14% (n = 560) of patients required intensive care, mean length of stay was 6.6 days, and in-hospital mortality was 1.7% (n = 66). In patients with available documentation, at admission, 61% (1344 of 2205) received dual (21%; 455) or triple (40%; 889) maintenance inhaler therapy. At discharge, 77% (2573 of 3326) of patients were prescribed GOLD-concordant inhaler therapy (dual: 28%; 939 and triple: 52%; 1720). In multivariable analyses, guideline-concordant prescribing at discharge was independently associated with longer length of stay (odds ratio [OR] 1.17/day; 95% CI 1.06-1.29), male sex (OR 1.45; CI 1.23-1.71), treatment on a pneumology ward (OR 1.77; 1.42-2.20), and older age (OR 0.87 per standard deviation increase; CI 0.79-0.95). Interpretation: In this multicentric large, real-world, hospital-based cohort of patients with severe COPD exacerbations, more than one in five patients were discharged without guideline-concordant maintenance inhaler therapy. Specialist pneumological care and structured inpatient management were strongly associated with improved adherence. Hospital care substantially increased maintenance therapy rate. Systematic implementation of eosinophil risk stratification, enhanced specialist involvement, and standardised discharge pathways could be opportunities and may substantially improve evidence-based COPD care and reduce future exacerbation risk. Funding: This study and the preparation of the manuscript were financially supported by AstraZeneca.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.