GOLD COPD categories are not fit for purpose in primary care

Jones, Rupert; Price, David; Chavannes, Niels H.; Molen, Thys van der; Thomas, Michael; Tsiligianni, Ioanna; Williams, Siân

doi:10.1016/s2213-2600(13)70015-8

Cited by 15 publications

(9 citation statements)

References 4 publications

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“… 8 , 10 This may be related to perceptions that the new GOLD categories have limited application in primary care and the previous suggestion that development of new treatment algorithms should involve the primary care community in order to fully engage their support. 18 …”

Section: Discussionmentioning

confidence: 99%

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

Davis

Landis

et al. 2014

COPD

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AimUtilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists.Materials and methodsPhysicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios.ResultsPhysicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001) to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001). Respiratory specialists were more likely than PCPs to report awareness of the GOLD global strategy (93% versus 58%, P<0.001); however, when presented with patient scenarios, they did not always perform better than PCPs with regard to recommending GOLD-concordant treatment options. The proportion of PCPs and respiratory specialists providing first- or second-choice treatment options concordant with GOLD strategy for a GOLD B-type patient was 38% versus 67%, respectively. For GOLD C and D-type patients, the concordant proportions for PCPs and respiratory specialists were 40% versus 38%, and 57% versus 58%, respectively.ConclusionThis survey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use of guideline-recommended COPD diagnostic practices was reported; however, gaps in the application of COPD-treatment recommendations were observed, warranting further evaluation to understand potential barriers to adopt guideline recommendations.

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Section: Discussionmentioning

confidence: 99%

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

Davis

Landis

et al. 2014

COPD

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“…The usefulness of these indices will be determined by their application in primary care [35] and the possibility of personalized treatment, as has been established for a considerable time for cardiovascular diseases. Multi-dimensional scales are tools that should be analysed and used in relation to these guidelines [36].…”

Section: Discussionmentioning

confidence: 99%

External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort)

et al. 2016

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BackgroundDue to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient’s lifestyle, social network and adherence to treatment.MethodsDesign: External validation of scales, open and prospective cohort study in primary care.Setting: 36 health centres in 6 European high, medium and low income countries.Subjects: 477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse.Predictors: Detailed patient history, exacerbations, lung function test and questionnaires at baseline.Outcomes: Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment.Analysis: Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis.DiscussionThe Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients.Trial registration ISRCTN52402811. Date: 15/01/2015. Prospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0305-2) contains supplementary material, which is available to authorized users.

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“…If the current three-domain assessment system proposed by GOLD4 has already been criticised because of its complexity,76 needless to say a much more complex system like the one proposed here may not be well received. Yet the answer is not difficult and may come from other fields such as engineering.…”

Section: The Copd Future: Personalised (P4) Medicinementioning

confidence: 98%

The path to personalised medicine in COPD

Agustí

2014

Thorax

168

107

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Our understanding of chronic obstructive pulmonary disease (COPD) has changed dramatically over the past two decades. We have moved from an airflow limitationcentric view to the realisation that COPD is a complex and heterogeneous disease, which leads inevitably to the need for personalising the assessment and treatment of patients with COPD. This review provides a brief perspective of the extraordinary transition that the COPD field has experienced in the last two decades, and speculates on how it should/can move forward in the near future in order to really achieve the goal of personalising COPD medicine in the clinic.

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GOLD COPD categories are not fit for purpose in primary care

Cited by 15 publications

References 4 publications

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort)

The path to personalised medicine in COPD

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