COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners

Abstract

Background:

Guideline recommendations for COPD management are only partially applied within primary care clinical practice.

Objective:

To compare the COPD management by Italian general practitioners (GPs) according to either the old GOLD (oGOLD) or the new GOLD (nGOLD) guidelines.

Research design and methods:

Observational study in different Italian areas. A total of 176 GPs enrolled their patients with a COPD diagnosis. Questionnaires were used to collect data on: COPD symptoms, disease severity, exacerbations, prescribed pharmacological and non-pharmacological treatments. COPD severity was estimated according to oGOLD and nGOLD guidelines.

Results:

A total of 526 subjects had complete information to assess COPD severity level according to guidelines (symptoms level, spirometry, history of exacerbations). The investigated subjects were more frequently males (71.2%) with a mean age of 72.5 years, and ex-smokers (44.4%). GPs reported sufficient control of the disease in 47.2% of the subjects with over two exacerbations in the last 12 months. Most patients have moderate COPD (51.5%), according to oGOLD, and belong to D groups (high risk, more symptoms) (45.6%), according to nGOLD. Overall, a low use of post-bronchodilator spirometry (65.1%) and of pulmonary rehabilitation (13.4%) was shown. The results highlighted a low prescriptive appropriateness but with higher value according to nGOLD than oGOLD: 61.4% vs 35.6%.

Study limitations:

Prescription data only provide limited information to judge prescribing quality, thus the results have to be evaluated with caution; moreover, this study was not designed to assess the difference between oGOLD and nGOLD.

Conclusions:

Guideline recommendations are applied only partially within clinical practice. A higher prescriptive appropriateness is shown by GPs using nGOLD classification. This might be due to the fact that nGOLD, with respect to oGOLD, takes into account anamnestic usual features considered by GPs in their clinical practice.

Keywords::

• COPD
• General practitioners
• GOLD guidelines
• Prescriptions pattern

Transparency

Declaration of funding

This work was supported by the Italian Health Ministry, project no. GR-2007-688717.

Declaration of financial/other relationships

S.M., S.B., F.M., S.C., G.S., M.B., A.P.P., N.M., and G.V. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors wish to acknowledge the COMODHES study group:

UO Pisa: Istituto di Fisiologia Clinica CNR, Pisa: Anna Antonietta Angino, Sandra Baldacci, Marco Borbotti, Laura Carrozzi, Sonia Cerrai, Sara Maio, Franca Martini, Anna Paola Pala, Bona Barbara Piegaia, Francesco Pistelli, Giuseppe Sarno, Patrizia Silvi, Giovanni Viegi.

UO Roma: Dipartimento di Epidemiologia, Servizio Sanitario Regionale, Regione Lazio: Massimo Stafoggia, Nerina Agabiti, Valeria Belleudi; IRCCS San Raffaele Pisana: Giovanna Gallucci, Marco Santagati.

UO Perugia: Sezione di Medicina Interna e Scienze Oncologiche, Dipartimento di Medicina Clinica e Sperimentale dell’Università degli Studi di Perugia: Nicola Murgia.

UO Genova: Clinica Tisiologica e Pneumologica, Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova: Fulvio Braido.

The authors would also like to thank Mrs. Anna Angino for the initial statistical analysis and Mrs. Patrizia Silvi for her role in the organization of the field survey.

Lastly, the authors wish to thank all the GPs who actively collaborated in the study:

Northern Italy: Aosta: De Cristofaro Raffaela; Asti: Nuti Claudio Pietro; Bergamo: Fulgosi Alessandro, Lamera Giorgio, Zappa Mario, Nicoli Sergio, Finazzi Alfredo; Belluno: Bertelle Evandro; Bologna: Casadei Massimo, Cau Roberto; Brescia: Ciolina Giovanni, Giori Annamaria, Guarnera Lucia, Inverardi Franca, Lora Aprile Pierangelo, Smillovich Gianpaolo, Tabaglio Erminio; Cuneo: Serventi Giovanni; Cremona: Menonna Giuseppe; Forlì-Cesena: Zanelli Nicoletta, Zennaro Alessandro; Gorizia: Carloni Maria Cristina, Gonano Liliana; Milano: Basile Antonio, Grignani Stefano, Maccapani Roberto, Maggioni Adriano, Lo Faro Francesco; Modena: Mantovani Licia, Reggiani Claudia, Marazzi Mauro, Cassanelli Marco; Padova: Franzoso Federico, Simioni Giuliana, Fasolo Luigi; Pordenone: Agrusti Fernando, Gasparin Amedeo, Lucchini Guido, Verzotto Valeria; Pavia: Gabba Franco, Menini Mauro, Mussini Anton Maria, Negri Fabrizio; Sondrio: Glaviano Bruno, Invernizzi Giovanni, Catinella Vincenzo; La Spezia: Lupi Lorenzo, Messini Linda; Trento: Guerino Sebastiano; Torino: Piovano Giovanni, Aimetti Luca, Grand Paola, Marengo Ferruccio, Mezzasalma Giovanni, Ventriglia Giuseppe; Trieste: Giammarini Alberto; Udine: Chiuch Paola, Galai Marcello, Gangi Fabrizio, Paduano Romano, Tubaro Gianni, Passoni Laura, Molinari Laura; Varese: Colombo Valter, Calzolari Mauro; Verbano-Chiuso-Ossola: Zaninetti Piero; Vercelli: Aramini Enrico; Venezia: Cesaro Federico, Frascati Angelo, Granzotto Stefano, Severi Sandro, Samueli Cristiano; Vicenza: Novella Guido; Verona: Sfragara Ignazio, Volpigli Ivan, Galvani Federica.

Central Italy: Ancona: Marchionni Maurizio, Sebastianelli Giuliano; Ascoli Piceno: Michetti Michelino; Arezzo: Grifagni Marcello; Firenze: Fanciullacci Antonio; Frosinone: Carrano Francesco, Simeoni Alvaro; Grosseto: Garofalo Remigio; Latina: Mercuri Mauro, Mingarelli Claudio; Macerata: Canelli Bernardo; Massa-Carrara: Mannari Gianluca, Galli Giuseppe; Pistoia: Allori Antonella, Amorini Fausto, Bartoli Umberto, Venturi Enzo; Pesaro e Urbino: Bartolucci Dario, Gelardi Michele, Scattolari Gabriele; Roma: Antonaci Luciano, Bauzulli Nadia, Bruschelli Carla, Calzini Virgilio, Creo Maria Geltrude, Fari' Cinzia, Ferri Luana, Gatta Luigi, Le Voci Patrizia, Marchionne Maurizio, Marziale Dario, Mei Massimo, Milani Luigi, Moscatelli Marina, Nigro Antonio, Ottaviani Alessandro, Severi Maria Loretta, Tamburrino Antonio; Terni: Ferri Sergio, Rossi Alessandro, Verducci Maurizio.

Southern Italy and Islands: L’Aquila: Valletta Domenico; Bari: De Mola Cosimo, D'ambrosio Gaetano, Dell'Orco Mario Lucio, Paci Claudio, Grattagliano Ignazio; Benevento: Bove Emilio Mario; Brindisi: Silvestro Marco, Lisco Michele Giuseppe; Cagliari: De Muro Nicola, Vincis Giuseppe; Caserta: La Marca Anna, Mingione Francesco; Caltanissetta: Filetti Giuseppe, Mastrosimone Giuseppe, Varrica Gaetano; Catania: Mocciaro Raffaele; Catanzaro: Bellini Felice, Gallucci Michele, Gerace Antonio, Guerra Antonio, Milano Francesco, Ventura Vittorio; Foggia: De Cristofaro Aurelio Antonio, Sammarco Renato, Schiavone Ciro, Barbato Pasquale Claudio; Crotone: Talerico Pasquale; Lecce: De Maria Antonio Giovanni, De Paolis Tiberio, Ghionda Francesco, Metrucci Antonio; Napoli: Bernardi Giuseppe, Boncompagni Salvatore, Brancati Ciro, Fatigati Domenico, Montefusco Silvana, Piciocchi Antonio, Somma Stefano, Spina Giovanni, Varriale Antonio, Stellato Rita; Palermo: Fiaccavento Elio, Iraci Tindaro, Mazzola Vincenzo, Merlino Giovanni, Severino Pasquale, Simonetti Maria Teresa; Pescara: Mincarelli Vincenzo, Volpone Damiano Antonio; Potenza: Ciriello Antonio, Di Lascio Giacomo; Ragusa: Digiacomo Giovanni; Salerno: Sirico Luigi; Sassari: Pilo Sebastiano, Spissu Raffaellina; Taranto: Gallicchio Nicola, Urago Marco; Trapani: Milazzo Vito.

Previous presentation: Part of the data has been previously presented at the American Thoracic Society (ATS) 2013 Congress, Philadelphia International Conference, 17–22 May 2013, Philadelphia, Pennsylvania.