PURPOSE: Global Initiative for Chronic Obstructive Lung disease (GOLD) guidelines are universally accepted management guidelines for Chronic Obstructive Pulmonary disease (COPD). “COPD Indian guidelines-2003” were formulated to manage the disease specifically in resource poor countries like India where spirometry is often not available. The study was conducted to evaluate the clinical application of these COPD guidelines in diagnosing and staging COPD by comparing them with GOLD guidelines.
METHODS: 100 patients of suspected COPD were taken. As per the recommendations in “COPD Indian guidelines”, diagnosis and staging of COPD was done using history, clinical signs and symptoms, 6-minute walk test and Peak expiratory flow rate (PEFR) measurements. The results were compared with those obtained after spirometric evaluation (as recommended under GOLD guidelines).
RESULTS: Spirometry confirmed the diagnosis and staging in 77% of patients. (6% mild, 53% moderate and 18% severe COPD respectively). Diagnosis on the basis of symptoms (cough, expectoration and dyspnoea severity) and signs (hyperinflation, decreased breath sounds, respiratory failure) could be made in 83% and 75% of patients respectively. 6-minute walk test underestimated the severity of disease, whereas PEFR measurement was closer to spirometry in staging and revealed 16% patients as mild, 42% moderate and 31% as severe COPD. Positive predictive value of symptoms, signs and PEFR in staging COPD were 74%, 70%, 54% respectively.
CONCLUSION: Keeping spirometry as the gold standard, COPD can be diagnosed and staged using symptoms, signs and PEFR measurements (recommended under “COPD Indian Guidelines”), with reasonable and acceptable certainty. Spirometry should be used for confirmation of diagnosis, wherever available. 6-minute walk test may be better used to monitor the disease progression rather than staging.
CLINICAL IMPLICATIONS: Due to its simplicity, “COPD Indian guidelines-2003” may be followed for the diagnosis and staging of COPD in resource poor settings especially at primary health care level.
DISCLOSURE: Gurpreet Binepal, No Financial Disclosure Information; No Product/Research Disclosure Information