title: A year in the life of German patients with COPD: the DACCORD observational study.
abstract: BACKGROUND
  Randomized interventional trials generally recruit highly selected patients. In contrast, long-term, noninterventional studies can reflect standard of care of real-life populations. DACCORD (Die ambulante Versorgung mit langwirksamen Bronchodilatatoren: COPD-Register in Deutschland [Outpatient Care With Long-Acting Bronchodilators: COPD Registry in Germany]) is an ongoing observational study, conducted in primary and secondary care in Germany, aiming to describe the impact of disease and treatments on real-life patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Patients had a clinical and spirometry diagnosis of COPD, were aged ≥40 years, and were initiating or changing COPD maintenance medication. The only exclusion criteria were asthma and participation in a randomized clinical trial. Exacerbation data were collected every 3 months. COPD medication, COPD Assessment Test, and forced expiratory volume in 1 second (FEV1) were recorded at the end of the 1 year period.
  
  
  RESULTS
  In the 6 months prior to baseline, 26.5% of the 3,974 patients experienced ≥1 exacerbation, compared with 26.1% over the 1-year follow-up (annualized rate 0.384). Importantly, only previous exacerbations and not poor lung function alone predicted an increased exacerbation risk. There was a general shift to lower disease severity from baseline to 1 year, predominantly as a consequence of a lower proportion of patients considered at high risk due to exacerbations. COPD Assessment Test mean change from baseline was -1.9, with 48.9% of patients reporting a clinically relevant improvement. Overall persistence to medication was high, with 77.2% of patients still receiving the same class of medication at 1 year.
  
  
  CONCLUSIONS
  DACCORD suggests that in clinical practice, the large majority of COPD patients are symptomatic but seldom exacerbate and that widely used tools and treatment recommendations do not reflect this fully.
authors: Pulmonary Department, Mainz University Hospital, Mainz.
authors: Roland
authors: R
authors: Buhl
authors: Department of Sleep and Respiratory Medicine, Evangelical Hospital Göttingen-Weende, Bovenden.
authors: Carl-Peter
authors: CP
authors: Criée
authors: Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt am Main.
authors: Peter
authors: P
authors: Kardos
authors: Department of Medicine, Pulmonary, and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg; German Center for Lung Research, Marburg.
authors: Claus
authors: C
authors: Vogelmeier
authors: Clinical Research Primary Care, Novartis Pharma GmbH, Nürnberg.
authors: Nadine
authors: N
authors: Lossi
authors: Clinical Research Primary Care, Novartis Pharma GmbH, Nürnberg.
authors: Claudia
authors: C
authors: Mailänder
authors: Facharztforum Fürth, Fürth, Germany.
authors: Heinrich
authors: H
authors: Worth
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005541:Forced Expiratory Volume; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D063127:Secondary Health Care; D012720:Severity of Illness Index; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; COPD exacerbations; epidemiology