title: Adherence to GOLD guideline treatment recommendations among pulmonologists in Turkey.
abstract: BACKGROUND
  Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey.
  
  
  OBJECTIVE
  To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists.
  
  
  METHODS
  A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded.
  
  
  RESULTS
  Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting β2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid.
  
  
  CONCLUSIONS
  Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages.
authors.affiliation: Department of Pulmonary Diseases, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Sen
authors.affiliation: Pulmonary Diseases Department, Izmir Dr Suat Seren Surgery Training and Research Hospital, Izmir, Turkey.
authors.forename: Salih Zeki
authors.initials: SZ
authors.lastname: Guclu
authors.affiliation: Pulmonary Diseases Department, Istanbul Hospital, Istanbul, Turkey.
authors.forename: Isil
authors.initials: I
authors.lastname: Kibar
authors.affiliation: Pulmonary Diseases Department, Adana Prof Dr Nusret Karasu Pulmonary Diseases Hospital, Adana, Turkey.
authors.forename: Ulku
authors.initials: U
authors.lastname: Ocal
authors.affiliation: Pulmonary Diseases Department, Yedikule Pulmonary Diseases and Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Veysel
authors.initials: V
authors.lastname: Yilmaz
authors.affiliation: Pulmonary Diseases Department, Nihat Kitapçı Pulmonary Diseases and Surgery Hospital, Erzurum, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Celik
authors.affiliation: Pulmonary Diseases Department, Atatürk Pulmonary Diseases and Surgery Training and Research Hospital, Ankara, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Cimen
authors.affiliation: Department of Pulmonary Diseases, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: Fusun
authors.initials: F
authors.lastname: Topcu
authors.affiliation: Pulmonary Diseases Department, Uskudar State Hospital, Istanbul, Istanbul, Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Orhun
authors.affiliation: Pulmonary Diseases Department, Samsun Pulmonary Diseases and Thoracic Surgery Hospital, Istanbul, Turkey.
authors.forename: Hikmet
authors.initials: H
authors.lastname: Tereci
authors.affiliation: Pulmonary Diseases Department, Novartis Pharmaceuticals, Istanbul, Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Konya
authors.affiliation: Pulmonary Diseases Department, Novartis Pharmaceuticals, Istanbul, Turkey.
authors.forename: Idilhan
authors.initials: I
authors.lastname: Ar
authors.affiliation: Department of Pulmonary Diseases, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Saryal
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015272:Pulmonary Medicine / Q000592:standards*; D014421:Turkey; D019564:Unnecessary Procedures / Q000592:standards
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
keywords: COPD; Global initiative for chronic Obstructive Lung Disease guidelines; Turkey; adherence; inhaled corticosteroid; overtreatment; treatment approach