COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners.
BACKGROUND
Guideline recommendations for COPD management are only partially applied within primary care clinical practice.


OBJECTIVE
To compare the COPD management by Italian general practitioners (GPs) according to either the old GOLD (oGOLD) or the new GOLD (nGOLD) guidelines.


METHODS
Observational study in different Italian areas. A total of 176 GPs enrolled their patients with a COPD diagnosis. Questionnaires were used to collect data on: COPD symptoms, disease severity, exacerbations, prescribed pharmacological and non-pharmacological treatments. COPD severity was estimated according to oGOLD and nGOLD guidelines.


RESULTS
A total of 526 subjects had complete information to assess COPD severity level according to guidelines (symptoms level, spirometry, history of exacerbations). The investigated subjects were more frequently males (71.2%) with a mean age of 72.5 years, and ex-smokers (44.4%). GPs reported sufficient control of the disease in 47.2% of the subjects with over two exacerbations in the last 12 months. Most patients have moderate COPD (51.5%), according to oGOLD, and belong to D groups (high risk, more symptoms) (45.6%), according to nGOLD. Overall, a low use of post-bronchodilator spirometry (65.1%) and of pulmonary rehabilitation (13.4%) was shown. The results highlighted a low prescriptive appropriateness but with higher value according to nGOLD than oGOLD: 61.4% vs 35.6%.


CONCLUSIONS
Prescription data only provide limited information to judge prescribing quality, thus the results have to be evaluated with caution; moreover, this study was not designed to assess the difference between oGOLD and nGOLD.


CONCLUSIONS
Guideline recommendations are applied only partially within clinical practice. A higher prescriptive appropriateness is shown by GPs using nGOLD classification. This might be due to the fact that nGOLD, with respect to oGOLD, takes into account anamnestic usual features considered by GPs in their clinical practice.
Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology , Pisa , Italy.
S
S
Maio
S
S
Baldacci
F
F
Martini
S
S
Cerrai
G
G
Sarno
M
M
Borbotti
A P
AP
Pala
N
N
Murgia
G
G
Viegi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058005:General Practitioners; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires
COPD; GOLD guidelines; General practitioners; Prescriptions pattern