COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners

Maio, Sara; Baldacci, Sandra; Martini, Franca; Sarno, Giuseppe; Borbotti, Marco; Pala, Anna Paola; Murgia, Nicola; Viegi, Giovanni

doi:10.1185/03007995.2014.884492

Cited by 31 publications

(22 citation statements)

References 20 publications

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“…To verify the sample's representativeness, we could confirm that the spectrum of bronchial obstruction severity (GOLD 1, 2, 3, 4) among the patients in the study closely resembled that of the COPD population, as officially reported [36]. As in a study recently conducted in Italy, the majority of patients in our study suffered from moderate COPD (46% vs. 51.5% in Italy), and belonged to the D category (43.7% objectively classified patients vs. 45.6% in Italy) [37].…”

Section: Discussionsupporting

confidence: 87%

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Koblížek

Pecen²,

Zatloukal

et al. 2014

PLoS ONE

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Chronic obstructive pulmonary disease (COPD) is a serious, yet preventable and treatable, disease. The success of its treatment relies largely on the proper implementation of recommendations, such as the recently released Global Strategy for Diagnosis, Management, and Prevention of COPD (GOLD 2011, of late December 2011). The primary objective of this study was to examine the extent to which GOLD 2011 is being used correctly among Czech respiratory specialists, in particular with regard to the correct classification of patients. The secondary objective was to explore what effect an erroneous classification has on inadequate use of inhaled corticosteroids (ICS). In order to achieve these goals, a multi-center, cross-sectional study was conducted, consisting of a general questionnaire and patient-specific forms. A subjective classification into the GOLD 2011 categories was examined, and then compared with the objectively computed one. Based on 1,355 patient forms, a discrepancy between the subjective and objective classifications was found in 32.8% of cases. The most common reason for incorrect classification was an error in the assessment of symptoms, which resulted in underestimation in 23.9% of cases, and overestimation in 8.9% of the patients' records examined. The specialists seeing more than 120 patients per month were most likely to misclassify their condition, and were found to have done so in 36.7% of all patients seen. While examining the subjectively driven ICS prescription, it was found that 19.5% of patients received ICS not according to guideline recommendations, while in 12.2% of cases the ICS were omitted, contrary to guideline recommendations. Furthermore, with consideration to the objectively-computed classification, it was discovered that 15.4% of patients received ICS unnecessarily, whereas in 15.8% of cases, ICS were erroneously omitted. It was therefore concluded that Czech specialists tend either to under-prescribe or overuse inhaled corticosteroids.

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Section: Discussionsupporting

confidence: 87%

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Koblížek

Pecen²,

Zatloukal

et al. 2014

PLoS ONE

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“…The overall finding of this study—that the prescribing of long‐acting bronchodilators and ICSs in patients with COPD does not appear to align with GOLD guidelines—is consistent with recent studies based on subgroups of patients in a variety of settings. Our observation that the most commonly dispensed first regimen involving a long‐acting bronchodilator was a LABA in combination with an ICS is consistent with findings from Spain, the Netherlands and some, but not all, studies based in the UK.…”

Section: Discussionsupporting

confidence: 83%

“…Recent studies in diverse settings have found that prescribing practice does not conform to international or national COPD treatment guidelines, or drug licencing conditions. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, these investigations have been based on subgroups of patients drawn from selected general practices, health insurance databases, or respiratory outpatient clinics or hospitals, and none have examined the longitudinal patterns of use of long-acting bronchodilator therapy in new users across an entire country.…”

Section: Summary At a Glancementioning

confidence: 99%

Patterns of use of long‐acting bronchodilators in patients with COPD: A nationwide follow‐up study of new users in New Zealand

et al. 2017

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“…Previous studies have mainly investigated resources,12–14,16 and the identification of underutilization is very important. The finding is consistent with an Italian study of COPD management where general practitioners stated that 13% of patients were referred to pulmonary rehabilitation in29 and with a Swiss study of patients referred to hospitals due to exacerbation, where 27% had participated in pulmonary rehabilitation 30. Suggested reasons for barriers to rehabilitation are lack of awareness of pulmonary rehabilitation in both patients and health care professionals, low access, low perceived health benefits, and comorbidity 31.…”

Section: Discussionsupporting

confidence: 89%

Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

Sundh¹,

Lindgren²,

Hasselgren³

et al. 2017

COPD

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IntroductionPulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden.Materials and methodsData on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year.ResultsIn primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals.ConclusionPulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD.

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COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners

Cited by 31 publications

References 20 publications

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Patterns of use of long‐acting bronchodilators in patients with COPD: A nationwide follow‐up study of new users in New Zealand

Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

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COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners

Cited by 31 publications

References 20 publications

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Real-Life GOLD 2011 Implementation: The Management of COPD Lacks Correct Classification and Adequate Treatment

Patterns of use of long‐acting bronchodilators in patients with COPD: A nationwide follow‐up study of new users in New Zealand

Pulmonary rehabilitation in COPD &ndash; available resources and utilization in Swedish primary and secondary care

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Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care