RETROSPECTIVE ANALYSIS OF THE DIAGNOSIS AND TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN LITHUANIA

Abstract

Chronic obstructive pulmonary disease (COPD) diagnosis and management in Lithuania remain suboptimal. A
retrospective analysis of Foxus system data (2023–2024) revealed that out of 1.1 million patients, only 11,693 had a recorded COPD (J44) diagnosis, although diagnostic algorithms identified as many as 146,740 patients at risk. The first electronic alert for potential COPD was triggered 147,022 times; however, referral to a pulmonologist was made for only 7.8% (n=11,494), with COPD confirmed in 13.5% of those cases. When COPD was first diagnosed, 57.4% of patients were prescribed a combination of a long-acting β2 agonist and a long-acting muscarinic receptor antagonist (LAMA/LAMA), 41.1% were prescribed a combination of LABA, LAMA, and inhaled corticosteroid (ICS), and 5.6% of patients were not prescribed pharmacotherapy. The treatment optimization algorithm generated 4,610 alerts, yet only 21.6% (n=995) of patients were referred for a pulmonologist consultation to review and adjust therapy; treatment was subsequently modified in 37.2% of them. Patients referred for treatment optimization were most often those already on LABA/LAMA/ICS triple therapy, indicating more severe disease, frequent exacerbations, and burdensome symptoms. These findings highlight the issue of clinical inertia: COPD is often diagnosed late, patients are referred to pulmonologists too infrequently, and treatment adjustments are delayed. Earlier intervention and optimization of therapy could potentially slow disease progression before compensatory mechanisms are exhausted, thereby improving patients’ quality of life. Systemic, technological, and educational measures are needed to ensure effective COPD management in Lithuania.