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

Abstract

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.

The reasons for triple therapy in stable COPD patients in Japanese clinical practice

“… 19 Nishimura et al suggested that only 14% of COPD patients were treated with ICS in Japan when asthma was clinically excluded. 20 Percentages of patients on ICS therapy were 34%, 69%, 60%, and 50% in the present, Wurst’s, 13 Price’s, 14 and Koblizek’s 15 studies, respectively. Frequencies of concomitant asthma were 20%, 44%, 28%, and 0%, respectively, in the four studies, ie, patients with asthma were excluded in Koblizek’s study.…”

“…Koblizek et al reported that despite the high awareness of the GOLD 2011 strategy among Czech COPD specialists, its real-life implementation was rather insufficient. 15 They claimed that 15.5% of COPD patients received ICS unnecessarily, and in 12.2% of cases, ICS was omitted contrary to the guideline recommendations. Among the COPD subjects enrolled in the COPDGene Study, subjects who were on triple therapy had the highest frequencies of exacerbations and severe exacerbations compared to others.…”

A review of national guidelines for management of COPD in Europe

“…An evaluation of 1355 patients with COPD in the Czech Republic indicated that 32.8% of cases were misclassified according to GOLD categories. Furthermore, 15.4% of patients received ICS unnecessarily, whereas in 15.8% of cases ICS were erroneously omitted [ 75 ]. In a French cohort study, ICS were prescribed outside their indications in ∼75% of patients if the “old” GOLD guidelines were taken as the reference, and in one-third when considering the new GOLD document [ 76 , 77 ].…”

Factors associated with the prescription of inhaled corticosteroids in GOLD group A and B patients with COPD – subgroup analysis of the Taiwan obstructive lung disease cohort

“…These results are similar to a study from the United Kingdom, in which 38% of GOLD stage I or II COPD patients were overprescribed ICS. 6 Recently, a study conducted by Koblizek et al 7 in the Czech Republic also found that 19.5% of COPD patients were overprescribed ICS.…”