General practitioner's adherence to the COPD GOLD guidelines: baseline data of the Swiss COPD Cohort Study

Abstract

PRINCIPLES: Chronic obstructive pulmonary disease (COPD) is a major burden on patients and healthcare systems. Diagnosis and the management of COPD are often administered by general practitioners (GPs). This analysis investigated the adherence of GPs in Switzerland to the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guidelines. METHODS: As part of an ongoing investigation into the effect of GPs prescriptions on the clinical course of COPD, 139 GPs submitted a standardised questionnaire for each COPD patient recruited. Information requested included spirometric parameters, management and demographic data. Participating GPs were provided with and received instruction on a spirometer with automatic feedback on quality. Patients were grouped by the investigators into the GOLD COPD severity classifications, based on spirometric data provided. Data from the questionnaires were compared between the groups and management was compared with the recommendations of GOLD. RESULTS: Of the 615 patients recruited, 44% did not fulfil GOLD criteria for COPD. Pulmonary rehabilitation was prescribed to 5% of all patients and less than one-third of patients exercised regularly. Less than half the patients in all groups used short-acting bronchodilators. Prescribing long-acting bronchodilators or inhaled corticosteroids conformed to GOLD guidelines in two-thirds of patients with GOLD stage III or IV disease, and approximately half of the less severe patients. Systemic steroids were inappropriately prescribed during stable disease in 6% of patients. CONCLUSIONS: Adherence to GOLD (COPD) guidelines is low among GPs in Switzerland and COPD is often misdiagnosed or treated inappropriately. This is probably due to poor knowledge of disease definitions.

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

“…The driving force behind "QualiCCare" was the mounting evidence that patients with chronic health conditions do not receive recommended care despite existing clinical practice guidelines (5). This is a problem in particular for patients with COPD, who receive recommended treatment only during 50% of encounters with providers (6)(7)(8).…”

Compare the efficacy and safety of long-acting anticholinergic and a combination of inhaled steroids and long-acting beta-2 agonist in moderate chronic obstructive pulmonary disease

“…This is also reflected in prescription rates in real life; i.e. combinations are more frequently prescribed than long-acting beta agonists alone (12)(13)(14).…”

Addressing unmet needs in the treatment of COPD

“…In accordance with the GOLD strategy, ICS plus LABA combinations should only be prescribed in patients who are at high risk of exacerbation [1]. In practice, however, ICS/LABAs are prescribed inappropriately in many patients with COPD, including those at low exacerbation risk [50][51][52].…”

“…Patients with COPD are frequently prescribed inappropriate medications according to their symptoms and risk level [50,52,53]. Both the over-and under-treatment of COPD have been observed, with misdiagnosis of COPD leading to inappropriate treatment of the condition, or no treatment at all [54][55][56].…”