title: Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study.
abstract: BACKGROUND
  Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline.
  
  
  METHODS
  We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations.
  
  
  RESULTS
  We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort.
  
  
  CONCLUSIONS
  A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative.
authors.affiliation: University Hospital of Gran Canaria Dr Negrín, Respiratory Service, Las Palmas de Gran Canaria, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cabrera
authors.affiliation: University Hospital Nuestra Señora de la Candelaria, Respiratory Service, Santa Cruz de Tenerife, Spain.
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.affiliation: Arucas Health Center, Primary Care Las Palmas de Gran Canaria, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Martín
authors.affiliation: Arucas Health Center, Primary Care Las Palmas de Gran Canaria, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Mirabal
authors.affiliation: Cueva Torres Health Center, Primary Care Las Palmas de Gran Canaria, Spain.
authors.forename: María Del Carmen
authors.initials: Mdel C
authors.lastname: Sánchez
authors.affiliation: La Feria Health Center, Primary Care Las Palmas de Gran Canaria, Spain.
authors.forename: Felisa
authors.initials: F
authors.lastname: Álvarez
authors.affiliation: University Hospital of Gran Canaria Dr Negrín, Respiratory Service, Las Palmas de Gran Canaria, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Juliá
authors.affiliation: University Hospital of Gran Canaria Dr Negrín, Respiratory Service, Las Palmas de Gran Canaria, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cabrera-Navarro
authors.affiliation: University Hospital of Gran Canaria Dr Negrín, Investigation Unit, Las Palmas de Gran Canaria, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: García-Bello
authors.affiliation: University Hospital Miguel Servet, Respiratory Service, Zaragoza, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Marín
authors.affiliation: Navarra University Clinic, Respiratory Service, Pamplona, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: de-Torres
authors.affiliation: Brigham and Women's Hospital, Pulmonary and Critical Care Service, Boston, MA, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Divo
authors.affiliation: Brigham and Women's Hospital, Pulmonary and Critical Care Service, Boston, MA, USA.
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Celli
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000465:Algorithms; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D018450:Disease Progression; D004417:Dyspnea / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D019983:Guideline Adherence; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013030:Spain
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; algorithm; primary care; treatment