Abstract
Background and objectives: Data about pulmonologist adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines showed a great variability and cannot be extrapolated. The present study investigates the current pharmacological prescribing practices in the treatment of chronic obstructive pulmonary disease (COPD) according to the 2017 GOLD guidelines, to determine the level of pulmonologist adherence and to identify possible factors that influence physician adherence. Materials and methods: This retrospective study took place between 1 February and 30 April 2018 in Pneumophtysiology Clinical Hospital Cluj-Napoca. We included 348 stable COPD outpatients classified according to the 2017 GOLD strategy in the ABCD risk groups. Pulmonologist adherence was defined as appropriate if the recommended pharmacological therapy was the first- or alternative-choice drug according to the guidelines, and inappropriate (overtreatment, undertreatment) if it was not in line with these recommendations. Results: The most prescribed treatment was the combination long-acting beta agonist (LABA) + long-acting antimuscarinic agent (LAMA) (34.77%), followed by LAMA + LABA + inhaled corticosteroid (ICS). Overall, pneumologist adherence was 79.02%. The most inappropriate therapies were in Group B (33.57%), followed by 33.33% in Group A. Compared to Groups C and D (analyzed together), Groups A and B had a 4.65 times higher chance (p = 0.0000001) of receiving an inappropriate therapy. Patients with cardiovascular comorbidities had a 1.89 times higher risk of receiving an inappropriate therapy (p = 0.021). ICS overprescription was the most common type of inappropriateness (17.81%). Groups C and D had a 3.12 times higher chance of being prescribed ICS compared to Groups A and B (p = 0.0000004). Conclusions: Pulmonologist adherence to the GOLD guidelines is not optimal and needs to be improved. Among the factors that influence the inappropriateness of COPD treatments, cardiovascular comorbidities and low-risk Groups A and B are important. ICS represent the most prescribed overtreatment. Further multicentric studies are needed to evaluate all factors that might influence the adherence rate.
Highlights
Chronic obstructive pulmonary disease (COPD) remains one of the leading global causes of mortality and morbidity [1], estimated to be the third most common cause of death by 2020 [2]
The chronic obstructive pulmonary disease (COPD) guidelines are important for the management of the disease [4], in a number of countries, low levels of adherence to the guideline recommendations were recorded among doctors treating different patient cohorts [4,7,8,9,10,11,12,13,14], often with overtreatment with inhaled corticosteroids (ICS) [13]
The study included 348 patients consulted by 15 pulmonologists; 325 patients were excluded due to a lack of a COPD stage/group being documented in their record
Summary
Chronic obstructive pulmonary disease (COPD) remains one of the leading global causes of mortality and morbidity [1], estimated to be the third most common cause of death by 2020 [2]. The. 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were designed to provide healthcare professionals with the most appropriate recommendations for the diagnosis and management of COPD patients. The COPD guidelines are important for the management of the disease [4], in a number of countries, low levels of adherence to the guideline recommendations were recorded among doctors treating different patient cohorts [4,7,8,9,10,11,12,13,14], often with overtreatment with inhaled corticosteroids (ICS) [13]. The present study investigates the current pharmacological prescribing practices in the treatment of chronic obstructive pulmonary disease (COPD) according to the 2017 GOLD guidelines, to determine the level of pulmonologist adherence and to identify possible factors that influence physician adherence.
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