title: Patterns of care for COPD by Japanese physicians.
abstract: OBJECTIVE
  COPD treatment guidelines are available worldwide, yet it is not known how widely they are followed. This study evaluated the clinical care of COPD patients in Japan as compared to guideline recommendations.
  
  
  METHODS
  A sample of general and specialist physicians was selected from private outpatient clinics and public hospitals in Japan. Physicians were provided two clinical vignettes (COPD and asthma) and asked to make a diagnosis. They were next asked to define diagnostic tests and treatment recommendations specifically for a COPD patient. Responses were compared to recommendations from current COPD guidelines.
  
  
  RESULTS
  For the COPD unknown vignette, 6.2% of physicians diagnosed COPD while 54% diagnosed chronic bronchitis or emphysema. For COPD diagnosis, 81.9% of physicians recommended a CXR, 49.1% spirometry, and 17.7% a computed tomography scan. The most frequently recommended medication for a newly diagnosed COPD patient was theophylline (37.2%) followed by expectorants (32.1%) and inhaled anticholinergics (25.9%). Inhaled beta-agonists were recommended by fewer than 20% of all physicians.
  
  
  CONCLUSIONS
  Care for COPD patients by selected Japanese physicians diverges from published practice guidelines. COPD is an infrequently used diagnostic label; diagnostic evaluation is characterized by a high use of computed tomography scans, particularly by specialists; and bronchodilator use was low.
authors.affiliation: Kyoto University, Kyoto, Japan. fukuhara@pbh.med.kyoto-u.ac.jp
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nishimura
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nordyke
authors.forename: Carol A
authors.initials: CA
authors.lastname: Zaher
authors.forename: John W
authors.initials: JW
authors.lastname: Peabody
mesh_terms: D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D006779:Hospitals, Public; D006801:Humans; D007564:Japan; D010820:Physicians / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000592:standards*