PRINCIPLES: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines aim to optimise chronic obstructive pulmonary disease (COPD) diagnosis and treatment. However, little is known about the extent to which general practitioners' (GP) adherence to GOLD guidelines improves patient outcomes. METHODS: In this questionnaire-based study, COPD patients were screened and enrolled; exacerbation history was recorded, and demographic, spirometric and management data were collected for 12 months. Spirometry was performed at least every 6 months according to American Thoracic Society guidelines. Based on these data, patients were grouped into GOLD COPD severity classifications. Data were expressed as the difference between baseline and month 12. RESULTS: Among 139 GPs, 454 patients were analysed regarding baseline and 12 month data. There was no significant change in distribution of GOLD COPD severity grades, lung function or guideline adherence. Chronic cough and sputum production were significantly reduced (p <0.001; p <0.020), as was exacerbation rate (p = 0.041). Factors associated with exacerbations were male sex, asthma and cerebrovascular insult as a co-morbidity. Exacerbation rate was significantly reduced in patients treated with combination therapy (long-acting β2-agonist (LABA)+ inhaled corticosteroids (ICS); p = 0.0178) and long-acting anticholinergics (LAAC; p = 0.0011). Patients treated per guidelines had no advantage in lung function, estimation of symptom prevalence or, most importantly, exacerbation rate. CONCLUSIONS: While there was no improvement in adherence to GOLD guidelines, disease severity was not affected detrimentally, suggesting that guideline adherence does not seem to impact symptom prevalence, exacerbation rate or lung function decline after one year of follow up.
PRINCIPLES: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines aim to optimise chronic obstructive pulmonary disease (COPD) diagnosis and treatment. However, little is known about the extent to which general practitioners' (GP) adherence to GOLD guidelines improves patient outcomes. METHODS: In this questionnaire-based study, COPD patients were screened and enrolled; exacerbation history was recorded, and demographic, spirometric and management data were collected for 12 months. Spirometry was performed at least every 6 months according to American Thoracic Society guidelines. Based on these data, patients were grouped into GOLD COPD severity classifications. Data were expressed as the difference between baseline and month 12. RESULTS: Among 139 GPs, 454 patients were analysed regarding baseline and 12 month data. There was no significant change in distribution of GOLD COPD severity grades, lung function or guideline adherence. Chronic cough and sputum production were significantly reduced (p <0.001; p <0.020), as was exacerbation rate (p = 0.041). Factors associated with exacerbations were male sex, asthma and cerebrovascular insult as a co-morbidity. Exacerbation rate was significantly reduced in patients treated with combination therapy (long-acting β2-agonist (LABA)+ inhaled corticosteroids (ICS); p = 0.0178) and long-acting anticholinergics (LAAC; p = 0.0011). Patients treated per guidelines had no advantage in lung function, estimation of symptom prevalence or, most importantly, exacerbation rate. CONCLUSIONS: While there was no improvement in adherence to GOLD guidelines, disease severity was not affected detrimentally, suggesting that guideline adherence does not seem to impact symptom prevalence, exacerbation rate or lung function decline after one year of follow up.
Authors: Thomas Keller; Laura J Spece; Lucas M Donovan; Edmunds Udris; Scott S Coggeshall; Matthew Griffith; Alexander D Bryant; Richard Casaburi; J Allen Cooper; Gerard J Criner; Philip T Diaz; Anne L Fuhlbrigge; Steven E Gay; Richard E Kanner; Fernando J Martinez; Ralph J Panos; David Shade; Alice Sternberg; Thomas Stibolt; James K Stoller; James Tonascia; Robert Wise; Roger D Yusen; David H Au; Laura C Feemster Journal: Chest Date: 2020-04-09 Impact factor: 9.410
Authors: Simona Tabea Huebner; Simona Henny; Stéphanie Giezendanner; Thomas Brack; Martin Brutsche; Prashant Chhajed; Christian Clarenbach; Thomas Dieterle; Adrian Egli; Martin Frey; Ingmar Heijnen; Sarosh Irani; Noriane Andrina Sievi; Robert Thurnheer; Marten Trendelenburg; Malcolm Kohler; Anne Barbara Leuppi-Taegtmeyer; Joerg Daniel Leuppi Journal: Respiration Date: 2021-12-23 Impact factor: 3.966
Authors: Kevin Gruffydd-Jones; Guy Brusselle; Rupert Jones; Marc Miravitlles; Michael Baldwin; Rebecca Stewart; Anna Rigazio; Emily Davis; Dorothy L Keininger; David Price Journal: NPJ Prim Care Respir Med Date: 2016-02-25 Impact factor: 2.871