Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece.MethodsThis was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece).ResultsThe mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A.ConclusionOur data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.
Highlights
Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders
It should be noted that two subjects < 40 years of age were mistakenly classified as eligible study participants, and their data were included into the analysis
It is worth mentioning that the main reason for designing this study around the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification and adherence to the 2017 revision is the lack of any national (Greek) guidelines published or proposed in COPD and the fact that most physicians of the country refer to the GOLD documents for the management of COPD
Summary
Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. According to current data on pathogenesis, COPD derives from various lifelong, dynamic, and cumulative interactions between genomic and environmental factors, that modulate the development, maintenance, and function of the lungs, through various biological mechanisms, including but not limited to airways’ and systemic inflammation [1] It is this diversity in the etiopathogenesis, pathophysiology and clinical manifestations that makes early, accurate diagnosis and management of COPD challenging. The socalled “ABCD” tool combines the data from spirometry, the modified British Medical Research Council questionnaire (mMRC) or the COPD Assessment Test (CAT) and the history of patient’s exacerbations to classify patients into four groups It has been noted though, that this classification had some limitations. Grading according to spirometry as well as group classification according to patientreported symptoms (CAT and mMRC assessment) and exacerbations were reported for each patient [9]
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