Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD

• Published in: International journal of chronic obstructive pulmonary disease Vol. 15; pp. 627 - 635
• Main Authors: Grewe, Fabian A, Sievi, Noriane A, Bradicich, Matteo, Roeder, Maurice, Brack, Thomas, Brutsche, Martin H, Frey, Martin, Irani, Sarosh, Leuppi, Jörg D, Thurnheer, Robert, Clarenbach, Christian F, Kohler, Malcolm
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2020; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: Aged; Airway management; Ambulatory care facilities; Analysis; Bronchodilator Agents; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical medicine; Conformity; Consent; Costs; Diseases; Drug therapy; Dyspnea; Female; global initiative for chronic obstructive lung disease guidelines; Guideline Adherence - statistics & numerical data; guideline-compliance; Humans; Longitudinal Studies; Lung diseases; Male; Medical research; Middle Aged; Original Research; Patient compliance; Patients; Physicians; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Roflumilast; Setting (Literature); Severity of Illness Index; Steroids; Switzerland; Switzerland; Global Initiative for Chronic Obstructive Lung Disease guidelines; guideline-compliance; chronic obstructive pulmonary disease
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S240444

To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting. This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA. Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%). The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.