Effective outpatient management of COPD requires prescription of
and adherence to appropriate therapies. Although practice guidelines
for outpatient management of COPD are widely available, evidence
suggests that these guidelines are not being implemented widely in
clinical practice. Furthermore, several studies have shown that patient
compliance with recommended therapy is poor. This paper discusses
several reasons why implementation of practice guidelines and adherence
with prescribed therapies may be poor. Potential clinical and economic
consequences of suboptimal management are reviewed. Although the
evidence suggests that improved compliance with guideline-recommended
practice will improve symptoms and disease-specific quality of life,
further work needs to be done to establish the cost-effectiveness of
chronic therapies for COPD relative to other chronic conditions.
Without such data, managed care organizations will be reluctant to
allocate scarce resources toward expensive guideline implementation
programs for individuals with this condition.