PURPOSE: Gold guidlines for COPD management include pharmacologic implementation of a stepwise treatment plan based on severity of disease.Use of therapeutic guidlines can improve and reduce the severity of exacerbations.This study examines the utilization of GOLD guidlines by physician specialty in the pharmacologic management of COPD outpatients admitted with acute exacerbation.
METHODS: A prospective study of 41 consecutive admissions to a pulmonary specialty floor with acute exacerbation of COPD as the primary diagnosis during a 12 month period. Exclusion criteria were endotracheal intubation and pneumonia.Data collection included age,gender,outpatient medication and spirometry.Spirometry if unavailable was performed just prior to discharge.Adherence to guidlines was analyzed by COPD stage and physician specialty.
RESULTS: Demographics: 41 patients; males: 24, females: 17. Mean age 72.3 yrs. Staging: stage 1: 2pts (5%), stage 2: 14pts (34%), stage 3: 17pts (41%), stage 4: 8pts (20%). GOLD recommended therapy by stage: stage 1: 1/2 (50%), stage 2: 7/14 (50%), stage 3: 5/17 (29%), stage 4: 6/8 (75%). Gold therapy by specialty: Internist 3/19 (15.7%), pulmonologist 2/2 (100%), combined internist and pulmonologist 13/17 (76.4%). No provider in 3 pts.
CONCLUSION: This analysis reveals very poor compliance with GOLD therapeutic recommendations by internists when they are the sole healthcareprovider. The combination of an internist and pulmonologist providing care leads to fair copliance with GOLD pharmacologic guidlines.
CLINICAL IMPLICATIONS: Further physician education is required to insure greater compliance with GOLD guidlines. Adherence to the GOLD guidelines can help reduce the frequency and severity of exacerbations and may decrease the need for hospitalization.
DISCLOSURE: Irina Zolotarevskaya, None.