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.
Highlights
Chronic obstructive pulmonary disease (COPD), a common disease frequently associated with pulmonary and extra-pulmonary co-morbidities, is an increasing cause of morbidity and mortality in contrast to some other major chronic diseases, such as coronary artery disease for which the mortality rate has been declining in developed countries [1]
We have developed an ongoing, questionnaire-based study designed to survey the standard of diagnosis of COPD by general practitioners (GPs) and the effect of prescriptions on the clinical course of COPD in patients seen by GPs in Switzerland
Of the COPD patients originally diagnosed with COPD, 44% did not fulfil Global Initiative for Chronic Obstructive Lung Diseases (GOLD) criteria for COPD
Summary
Chronic obstructive pulmonary disease (COPD), a common disease frequently associated with pulmonary and extra-pulmonary co-morbidities, is an increasing cause of morbidity and mortality in contrast to some other major chronic diseases, such as coronary artery disease for which the mortality rate has been declining in developed countries [1]. The Global Burden of Disease studies predicted that COPD will be the third most common cause of death and the fourth most common cause of morbidity by 2020 [2]. In response to the increasing burden, the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) was developed to increase awareness and decrease morbidity and mortality from COPD [3]. GOLD defines COPD as a disorder characterised by expiratory airflow limitation that is not fully reversible, is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases [3]. Diagnosis of COPD can be difficult and requires confirmation by spirometry [3]
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