Adherence to GOLD guideline treatment recommendations among pulmonologists in Turkey

Figures & data

Table 1 Patient characteristics by stage of disease

	Total	Stage I	Stage II	Stage III	Stage IV	P-value
		n=16	n=238	n=346	n=119
Age (years), mean ± SD	62.9±9.7	59.75±8.37	62.21±10.26	64.17±9.76d	61.24±7.94c	0.004z
Sex, n (%)
Male	614 (85.4)	16 (100.0)	189 (79.4)	303 (87.6)	106 (89.1)	0.007x
Female	105 (14.6)	0 (0.0)	49 (20.6)	43 (12.4)	13 (10.9)
Duration of disease (years), mean (SD)	6.0±5.8	4.19±82d	4.82±4.93c,d	6.18±5.34b	8.04±7.62a,b	<0.001z
FEV1 (L), mean (SD)	1.3±0.6	2.63±0.52b,c,d	1.66±0.46a,c,d	1.16±0.39a,b,d	0.75±0.24a,b,c	<0.001z
FEV1 (%), mean (SD)	44.9±15.8	88.56±9.31b,c,d	60.40±8.05a,c,d	39.39±5.56a,b,d	23.95±4.17a,b,c	<0.001z
Patients with health insurance, n (%)	685 (95.3)	16 (100.0)	229 (97.4)	323 (96.1)	117 (100.0)	0.149y
>20 pack-year smoking history, n (%)	525 (73)	14 (87.5)	169 (81.6)	248 (81.6)	94 (86.2)	0.655x
Smoking history, n (%)	642 (89.3)	16 (100.0)	210 (88.2)	306 (88.4)	110 (93.2)	0.222x
Active smoker	194 (27)	6 (37.5)	66 (31.4)	94 (30.7)	28 (25.5)	0.622x
Former smoker	448 (62.3)	10 (62.5)	144 (68.6)	212 (69.3)	82 (74.5)
Nonsmoker	76 (10.7)	0 (0.0)	28 (11.8)	40 (11.6)	8 (6.8)

Notes:

x Pearson’s chi-square test,

y Pearson’s chi-square test (Monte Carlo),

z Kruskal–Wallis test;

a Stage I,

b Stage II,

c Stage III,

d Stage IV (Mann–Whitney U-test with Bonferroni correction, P<0.008).

Abbreviation: FEV₁, forced expiratory volume in 1 second.

Table 2 Treatment adherence to GOLD 2010

GOLD stage	Appropriate treatment	n (%)	Inappropriate treatment	n (%)
I	Short-acting	1 (6.25)	LAMA	6 (37.5)
	bronchodilators when	1 (6.25)	LAMA-LABA	1 (6.25)
	needed		LABA-ICS	1 (6.25)
	Total		LAMA-T	1 (6.25)
			LABA-ICS-LAMA	6 (37.5)
			Total	15 (93.75)
II	LAMA	12 (5)	ICS	8 (3.4)
	LABA-LAMA	20 (8.4)	LABA-ICS	30 (12.6)
	LAMA-T	3 (1.3)	LAMA-ICS	4 (1.7)
	Total	35 (14.7)	ICS-SABA-SAMA	1 (0.4)
			LAMA/LAMA-ICS-T	6 (2.5)
			LABA-ICS-LAMA	113 (47.5)
			LABA-ICS-LAMA-T	31 (13)
			ICS-SABA-SAMA-T	1 (0.4)
			No drug use	9 (3.8)
			Total	203 (85.3)
III	LABA-ICS	30 (8.6)	LABA	2 (0.6)
	LAMA-ICS	1 (0.3)	LAMA	11 (3.2)
	LABA/LAMA-ICS-T	11 (3.2)	T	4 (1.2)
	LABA-ICS-LAMA	156 (45.1)	ICS	6 (1.7)
	LABA-ICS-LAMA-T	94 (27.2)	LABA-LAMA	5 (1.4)
	Total	292 (84.4)	LABA-T	1 (0.3)
			LAMA-T	5 (1.4)
			LABA-LAMA-T	1 (0.3)
			ICS-SABA-SAMA	11 (3.2)
			No drug use	8 (2.3)
			Total	54 (15.6)
IV	LABA-ICS	17 (14.3)	LABA	1 (0.8)
	LAMA-ICS	1 (0.8)	LAMA	1 (0.8)
	LABA/LAMA-ICS-T	7 (5.9)	ICS	5 (4.3)
	LABA-ICS-LAMA	37 (31.1)	LABA-LAMA	4 (3.4)
	LABA-ICS-LAMA-T	37 (31.1)	LABA-T	1 (0.8)
	Total	99 (83.2)	LABA-LAMA-T	1 (0.8)
			No drug use	7 (5.9)
			Total	20 (16.8)
Total		427 (59.4)		292 (40.6)

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting β2-agonist; SAMA, short-acting muscarinic antagonist; T, theophylline.

Table 3 Distribution of patients on bronchodilator alone, treatment containing ICS, and no maintenance drug by COPD stage

	No maintenance drugs, n (%)	Bronchodilator alone (no ICS), n (%)	Treatment containing ICS, n (%)
Stage I	1 (4)	8 (10)	7 (1.1)
Stage II	9 (36)	35 (43.8)	194 (31.6)
Stage III	8 (32)	29 (36.3)	309 (50.3)
Stage IV	7 (28)	8 (10)	104 (16.9)
Total	25 (100)	80 (100)	614 (100)

Abbreviation: ICS, inhaled corticosteroid.