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BackgroundThe gaps between evidence-based recommendations and real-world practice for management of chronic obstructive pulmonary disease (COPD) have been poorly characterised. We aimed to describe the progress of patients with COPD through the cascade of care.MethodsWe performed five systematic reviews and meta-analyses of observational studies evaluating the diagnosis and treatment of patients with COPD. We searched MEDLINE, Embase, CINAHL, Global Health, and the Cochrane Library for studies, published between January 2000 and December 2018, that reported data on the following five main components of patient care: diagnosis using spirometry, pharmacotherapy, smoking cessation, vaccination, and pulmonary rehabilitation. A random effects model was used to identify the proportion of patients with COPD completing each step in the cascade.FindingsWe identified 18, 32, 15, 48, and 36 studies for diagnosis, pharmacotherapy, smoking cessation, vaccination, and pulmonary rehabilitation components, respectively. Major gaps in the cascade included: assignment of a diagnosis of COPD among people with airflow obstruction and respiratory symptoms (29·7% [95% CI 13·1 – 54·3%]), adherence to maintenance inhalers up to 12 months (proportion of days covered: 30·9% [95% CI 18·3 – 47·1%]; medication possession ratio: 29·7% [95% CI 20·3 – 41·3%]), vaccination against S.pneumoniae (37·9% [95% CI 24·9 – 53·0%]), and referral for pulmonary rehabilitation (20·4% [95% CI 9·2 – 39·3%]).InterpretationSubstantial gaps were identified between evidence and practice for patients along the cascade of care for COPD. Further policies and actions are needed to address these gaps and reduce the global burden of COPD.FundingAustralian National Health and Medical Research Council.

Previous studies have included a limited number of randomized controlled trials (RCTs) and compared limited parameters after treatment with imidafenacin and other anticholinergic drugs (ADs) for overactive bladder syndrome (OAB), and controversy about the superiority of these ADs still remains. We aim to update the evidence and provide better clinical guidance. A systematic search of PubMed, Embase, ClinicalTrial.gov and Cochrane Library Central Register of Controlled Trials was conducted from January 2007 to April 2019. Meta-analysis of all published RCTs comparing imidafenacin with other ADs in patients with OAB was performed. The primary outcomes were the changes in OAB symptoms and OAB symptom score (OABSS). Secondary outcomes included adverse events (AEs) and the dropout rate related to AEs. A total of 6 studies including 7 RCTs involving 1430 patients with mean follow-up of 23.43 weeks were included. All ADs improved OAB symptoms. Regarding efficacy, these drugs had similar efficacy in voids, urgency episodes, urgency incontinence episodes, incontinence episodes and OABSS. However, imidafenacin performed better in the reduction of nocturia episodes (MD = –0.24, 95% CI –0.44 to –0.04, P = 0.02). Moreover, imidafenacin was associated with a statistically lower dry mouth rate (RR = 0.87, 95% CI 0.75–1.00, P = 0.04), lower constipation rate (RR = 0.68, 95% CI 0.50–0.93, P = 0.01) and lower AE-related withdrawal rate (RR = 0.51, 95% CI 0.29–0.89, P = 0.02). There was no significant difference in terms of other complications. In conclusion, imidafenacin was comparable to other ADs in the treatment of OAB. Moreover, imidafenacin presented a lower dry mouth rate, lower constipation rate and higher adherence and persistence.