PURPOSE: In Italy, COPD is usually referred for management to pulmonologists (P), general internists (I) or geriatricians (G). We wished to compare COPD knowledge and approach to management by these specialists in Italy.
METHODS: 895 Italian specialists were invited to complete a structured 60 question internet-based survey on various aspects of COPD management in April 2010. Questionnaire content was determined by a panel of pulmonologists, geriatricians and internists representing SIMREG, the Italian geriatric-pulmonary society.
RESULTS: 240 specialists, 80 each of P, G, I, evenly distributed throughout Italy completed the online survey (26.8% response rate). Respondents : 81% male; mean age 51 years; mean years of practice 18; primarily hospital-based (ward/clinic 65%; outpatient clinic 17%).Overall, specialists spent 35% of their practice time treating COPD, but this varied by specialty: P 52%, G 23%, I 28%. COPD management was considered to be very interesting/challenging by 60% of P, but only by 28% I and by 16% G. While all felt that dyspnea was a major problem for patients, the mechanism of dynamic hyperinflation in COPD was under appreciated by non-P specialists: P 88%, G 55%, I 63%. Phenotypic variation in COPD was felt to be important by only 49% P, 18% I and 6% G. All specialists felt that COPD was a complex disease that has a significant impact on patient quality of life, but only G (78%) consistently used a multidimensional assessment approach (P 30%, I 29%) and specifically assessed patient activities of daily living: G 78%, I 42%, P 37%.
CONCLUSION: There is significant variation in the approach to COPD management by specialist designation. G and to a lesser extent I tend to use a more holistic, less COPD-specific approach and find COPD management less challenging than P. Perhaps this reflects an under diagnosis and under appreciation of the complexities of COPD by non-pulmonary specialists.
CLINICAL IMPLICATIONS: Guidelines should promote greater awreness of the multidimensional aspects of COPD necessary for optimum holistic assessment and management by physicians with differing specialties.
DISCLOSURE: Richard Hodder, No Financial Disclosure Information; No Product/Research Disclosure Information