Management of COPD: pulmonologists' adherence to Polish guidelines

Abstract

Literature data suggest that management of COPD in primary care and by specialists differ from national or international guidelines. Aim of this investigation was to evaluate routine management of COPD by Polish pulmonologists and to compare it to COPD guidelines of the Polish Society of Lung Diseases published in 1997 and updated in 2004. Questionnaire containing 33 questions was distributed to 800 participants of a national congress of the Society. Response rate was 10%. Term COPD is used by 95% of responders (R). For 73% of R COPD patients count for more than 20% of their consultations. Clinical signs of cor pulmonale are present in 10% and signs of respiratory failure in 10 to 20% of all patients. Patients with mild, moderate, severe and very severe disease represent respectively 18, 48, 24 and 10% of the total. Spirometry is performed to confirm diagnosis by 81% of R. However, bronchodilating test is performed in all patients only by 34% of R. 97% of R give antismoking advice to all patients. Only 6% of R are current smokers and 61% are life nonsmokers. Bronchodilating treatment is commonly prescribed. Most frequently prescribed drugs are: LABA (65% of patients) short acting anticholinergic (44%) and ICS (21%) of patients. ICS are over prescribed and systemic steroids are still chronically used in somewhat less than 20% of patients. 43% of R give systemic steroids to all patients during exacerbation of severe disease. Results of the study should be taken with caution. Low response rate suggest that only physicians interested in the treatment of COPD patients participated. A real life situation is probably worse than presented. Pneumonol. Alergol. Pol. 2005, 73, 135-141 .