Real-life GOLD 2011 implementation: the management of COPD lacks correct classification and adequate treatment

PLoS One. 2014 Nov 7;9(11):e111078. doi: 10.1371/journal.pone.0111078. eCollection 2014.

Abstract

Chronic obstructive pulmonary disease (COPD) is a serious, yet preventable and treatable, disease. The success of its treatment relies largely on the proper implementation of recommendations, such as the recently released Global Strategy for Diagnosis, Management, and Prevention of COPD (GOLD 2011, of late December 2011). The primary objective of this study was to examine the extent to which GOLD 2011 is being used correctly among Czech respiratory specialists, in particular with regard to the correct classification of patients. The secondary objective was to explore what effect an erroneous classification has on inadequate use of inhaled corticosteroids (ICS). In order to achieve these goals, a multi-center, cross-sectional study was conducted, consisting of a general questionnaire and patient-specific forms. A subjective classification into the GOLD 2011 categories was examined, and then compared with the objectively computed one. Based on 1,355 patient forms, a discrepancy between the subjective and objective classifications was found in 32.8% of cases. The most common reason for incorrect classification was an error in the assessment of symptoms, which resulted in underestimation in 23.9% of cases, and overestimation in 8.9% of the patients' records examined. The specialists seeing more than 120 patients per month were most likely to misclassify their condition, and were found to have done so in 36.7% of all patients seen. While examining the subjectively driven ICS prescription, it was found that 19.5% of patients received ICS not according to guideline recommendations, while in 12.2% of cases the ICS were omitted, contrary to guideline recommendations. Furthermore, with consideration to the objectively-computed classification, it was discovered that 15.4% of patients received ICS unnecessarily, whereas in 15.8% of cases, ICS were erroneously omitted. It was therefore concluded that Czech specialists tend either to under-prescribe or overuse inhaled corticosteroids.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Czech Republic / epidemiology
  • Female
  • Humans
  • Male
  • Medicine
  • Patient Care / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / classification
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / therapy*

Grants and funding

The study was funded by Boehringer Ingelheim. The study was awarded the Czech Ministry of Health grant, number of reference: DRO(UHHK, 00179906). Boehringer Ingelheim has contributed to the study design by providing the outline for data input requested, conceiving the preliminary version of the doctors' questionnaire and supervising the study conduct throughout its course. The Czech Ministry of Health did not intervene in the study design or its conduct, except for its compliance assessment and registration. The funders had a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.