title: Impact of adherence to the GOLD guidelines on symptom prevalence, lung function decline and exacerbation rate in the Swiss COPD cohort.
abstract: BACKGROUND
  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.affiliation: Clinic of Internal Medicine, University Hospital of Basel, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Jochmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Scherr
authors.forename: Dirk Christian
authors.initials: DC
authors.lastname: Jochmann
authors.forename: David
authors.initials: D
authors.lastname: Miedinger
authors.forename: Salome Schafroth
authors.initials: SS
authors.lastname: Török
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: Jörg Daniel
authors.initials: JD
authors.lastname: Leuppi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003371:Cough / Q000209:etiology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D015444:Exercise; D005260:Female; D058006:General Practice; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D012907:Smoking; D013147:Spirometry; D013183:Sputum / Q000378:metabolism; D011795:Surveys and Questionnaires; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists