Level of Adherence to GOLD Guidelines for Management of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Is There a Difference Between Patient Management in Different Hospital Wards?

Abstract

Background: The purpose of this study was to evaluate the implementation of GOLD guideline in patients with an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methods: In a cross-sectional study, all patients with COPD exacerbation referred to Shariati hospital from January 2014 to March 2015 were investigated. The level of adherence to GOLD guideline in three areas of hospital admission, therapeutic components of inpatient management (pharmacologic treatments, respiratory support) and discharge plan was assessed via reviewing patients’ medical profile. Each subject was classified as complete, non-complete and not evaluated in terms of adherence to the guideline. Results: In this study, 125 patients with mean age of 67.64±1.71 years including 100 (80%) males were studied. Also, 104 and 21 patients were hospitalized in pulmonology and general medicine wards, respectively. In the present study, the adherence to GOLD recommendations for hospital admission, pharmacologic treatment and non-pharmacologic management were 92, 97.6 and 44.2%, respectively. Despite the high level of adherence to pharmacologic management, total adherence to non-pharmacologic interventions was poor. Conclusion: Although high level of adherence to pharmacological management of COPD was observed, there was overtreatment particularly in case of antibiotics prescription. In addition, non-pharmacological management was not considered in over half of the patients.