Do 'guidelines' really guide us?

Abstract

INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a disease that can be prevented and treated. It is characterized by permanent limitation of the airflow through respiratory tract, which is usually progressive and associated with an increased inflammatory response to noxious particles and gases in the airways and lungs. COPD is currently the fourth leading cause of death in the world. In 2013 Serbian Ministry of Health issued a National guideline for good clinical practice for the diagnosis and treatment of COPD. According to this guide, bronchodilators, administered through inhalation, are basic medications for COPD treatment. The basic treatment of COPD exacerbation involves the use of short-acting beta-2 agonists with or without anticholinergic drugs. Methylxanthines belong to the second-line medications, and they should be used only when short acting beta-2 agonists are not effective. OBJECTIVE The aim of this paper was to determine whether the patients with COPD exacerbation who came to the ambulance station of The City Institute for Emergency Medicine Belgrade (CIEMB) were treated according to the National Guideline. (As of September 2016. there is an inhaler in the ambulance station, as well as the solution for inhalation, salbutamol). Furthermore, we wanted to point out the challenges and limitations of COPD exacerbation treatment at ambulance stations. METHODS We have monitored the work of the CIEMB ambulance station from October 15, 2016, to January 20, 2017. Data on patients' complaints, physical status, diagnosis, and proposed treatment were taken from the regular medical protocols. RESULTS From the 3367 patients enrolled in the ambulance protocol in this period, 86 had the COPD diagnosis. Only 11 of them (12.7 %) were treated according to the National guideline (with inhaling short-acting beta-2 agonist). The others received second-line medications. CONCLUSION Guidelines are designed for the physicians so that they could apply the experiences of best medical practice. They support evidence based medicine and help individuals to combine knowledge and practice, and efficiency and effectiveness. Recently, several studies which monitor the implementation of protocols for COPD treatment were published. All of them indicated presence of deviation from currently valid guidelines. Responsibility for these results is equally borne by physicians, their available resources and patients too, as they often refuse new methods of treatment because they are used to the outdated intravenous therapy. In addition to the continuing education of physicians and constant encouragement for the use of all available new medications, it is necessary to educate patients about modern protocols for the COPD treatment.