Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 140 No. 3132 (2010)

General practitioners’ adherence to the COPD GOLD guidelines: baseline data from the Swiss COPD Cohort Study

  • A Jochmann
  • F Neubauer
  • D Miedinger
  • PN Chhajed
  • Török Schafroth
DOI
https://doi.org/10.4414/smw.2010.13053
Cite this as:
Swiss Med Wkly. 2010;140:w13053
Published
02.08.2010

Abstract

Principles: Chronic obstructive pulmonary disease (COPD) is a major burden on patients and healthcare systems. Diagnosis and the management of COPD are often administered by general practitioners (GPs). This analysis investigated the adherence of GPs in Switzerland to the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guidelines.

Methods: As part of an ongoing investigation into the effect of GPs prescriptions on the clinical course of COPD, 139 GPs submitted a standardised questionnaire for each COPD patient recruited. Information requested included spirometric parameters, management and demographic data. Participating GPs were provided with and received instruction on a spirometer with automatic feedback on quality. Patients were grouped by the investigators into the GOLD COPD severity classifications, based on spirometric data provided. Data from the questionnaires were compared between the groups and management was compared with the recommendations of GOLD.

Results: Of the 615 patients recruited, 44% did not fulfil GOLD criteria for COPD. Pulmonary rehabilitation was prescribed to 5% of all patients and less than one-third of patients exercised regularly. Less than half the patients in all groups used short-acting bronchodilators. Prescribing long-acting bronchodilators or inhaled corticosteroids conformed to GOLD guidelines in two-thirds of patients with GOLD stage III or IV disease, and approximately half of the less severe patients. Systemic steroids were inappropriately prescribed during stable disease to 6% of patients.

Conclusions: Adherence to GOLD (COPD) guidelines is low among GPs in Switzerland and COPD is often misdiagnosed or treated inappropriately. This is probably due to poor knowledge of disease definitions.

References

  1. Mannino DM, Brown C, Giovino GA. Obstructive lung disease deaths in the United States from 1979 through 1993. An analysis using multiple-cause mortality data. Am J Respir Crit Care Med. 1997;156:814–8.
  2. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349:1436–42.
  3. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Update 2008.
  4. Russi EW, Leuenberger P, Brändli O, et al. Management of chronic obstructive pulmonary disease: the Swiss guidelines. Official Guidelines of the Swiss Respiratory Society. Swiss Med Wkly. 2002;132:67–78.
  5. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256–76.
  6. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–55.
  7. Buffels J, Degryse J, Decramer M; DIDASCO Study. Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO Study. Chest. 2004;125:1394–9.
  8. Wouters EF. The burden of COPD in The Netherlands: results from the Confronting COPD survey. Respir Med. 2003;97(Suppl C):S51–9.
  9. © Bundesamt für Statistik, N. Anzahl und Dichte der berufstätigen Ärzte und Zahnärzte. 2007. http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/03/03/key/01.html.
  10. Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med. 1994;152:1107–36.
  11. Perez-Padilla R, Vazquez-Garcia JC, Márquez MN, et al. The long-term stability of portable spirometers used in a multinational study of the prevalence of chronic obstructive pulmonary disease. Respir Care. 2006;51:1167–71.
  12. Brändli O, Schindler C, Künzli N, Keller R, Perruchoud AP. Lung function in healthy never smoking adults: reference values and lower limits of normal of a Swiss population. Thorax. 1996;51:277–83.
  13. Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective. Respirology. 2005;10:9–17.
  14. Rutschmann OT, Janssens JP, Vermeulen B, Sarasin FP. Knowledge of guidelines for the management of COPD: a survey of primary care physicians. Respir Med. 2004;98:932–7.
  15. Schneider A, Gantner L, Maag I, Borst MM, Wensing M, Szecsenyi J. Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study. BMC Health Serv Res. 2005;5:11.
  16. Jones RC, Dickson-Spillmann M, Mather MJ, Marks D, Shackell BS. Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit. Respir Res. 2008;9:62.
  17. Yawn BP. Differential assessment and management of asthma vs chronic obstructive pulmonary disease. Medscape J Med. 2009;11:20.
  18. Schermer TR, Jacobs JE, Chavannes NH, Hartman J, Folgering HT, Bottema BJ, van Weel C. Validity of spirometric testing in a general practice population of patients with chronic obstructive pulmonary disease (COPD). Thorax. 2003;58:861–6.
  19. Leuppi JD, Miedinger D, Chhajed PN, Buess C, Schafroth S, Bucher HC, Tamm M. Quality of spirometry in primary care for case finding of airway obstruction in smokers. Respiration. 2010;79(6):469-74. Epub 2009 Sep 26.
  20. Evans RA, Singh SJ, Collier R, Williams JE, Morgan MD. Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respir Med. 2009;103:1070–5 [E-pub 13 Feb 2009].
  21. Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359:1543–54.
  22. Tashkin DP, Donohue JF, Mahler DA, et al. Effects of arformoterol twice daily, tiotropium once daily, and their combination in patients with COPD. Respir Med. 2009;103:516–24.
  23. Bourbeau J, Sebaldt RJ, Day A, et al. Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: the CAGE study. Can Respir J. 2008;15:13-9.
  24. Gartlehner G, Hansen RA, Carson SS, Lohr KN, et al. Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes. Ann Fam Med. 2006;4:253–62.
  25. Calverley PM, Anderson JA, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–89.
  26. Crim, C., P. M. Calverley, et al. “Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results.” Eur Respir J. 2009;34(3):641–7.
  27. Vondracek SF, Hemstreet BA. Is there an optimal corticosteroid regimen for the management of an acute exacerbation of chronic obstructive pulmonary disease? Pharmacotherapy. 2006;26:522–32.
  28. Siebeling L, Ter Riet G, van der Wal WM, et al. ICE COLD ERIC – International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts – study protocol for an international COPD cohort study. BMC Pulm Med. 2009;9:15.
  29. Miedinger D, Linz A, Praehauser C, Chhajed PN, Buess C, Schafroth Török S, Bucher HC, Tamm M, Leuppi JD. Patient-reported respiratory symptoms and pre-bronchodilator airflow limitation among smokers in Switzerland. Prim Care Respir J. 2010;19(2):163-9.