GOLD guidelines emphasize the need of spirometery for diagnosis and management of COPD.However, in developing countries who share the major burden of COPD spirometery is not universally available hence an alternate strategy avoiding spirometery need to be developed.
50 patients each in Group A & B were studied. Group A were classified on spirometery and managed managed as per GOLD guidelines and Group B graded on symptoms/dyspnea based approach. A comparision made of outcome measures like exacerbations,hospital visits/hosptallizaion.Group B was classified acording to no dyspnea, dyspnea on unaccustomed exercise, on accustomed exercise,on normal routines of life or on lying in the bed and also on basis of cyanosis, oedema feet or CCF.
Exacerbtion were equal (16%)in both the groups.12% of Group A & 16% of Group B patients were lost to folow up.Time for symptomatic imrovement was delayed in Group B but was not statitically significant.Patients when classified according to alternate strategy were falling in lower grade of spirometery based Gold guidelines and thus received lower grade of treatment.
COPD can be graded and managed according to symptoms/dyspnea based approach. Even GOLD guidelines based management shoul be validated thoroughly.
In resource poor countries symptoms/dyspnea based COPD management can be employed.
Jai Kishan, None.