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Objective To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting. Methods This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA. Results Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%). Conclusion The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.

Elif Sen,1 Salih Zeki Guclu,2 Isil Kibar,3 Ulku Ocal,4 Veysel Yilmaz,5 Onur Celik,6 Filiz Cimen,7 Fusun Topcu,8 Meltem Orhun,9 Hikmet Tereci,10 Aylin Konya,11 Idilhan Ar,11 Sevgi Saryal11Department of Pulmonary Diseases, Ankara University School of Medicine, Ankara, 2Pulmonary Diseases Department, Izmir Dr Suat Seren Surgery Training and Research Hospital, Izmir, 3Pulmonary Diseases Department, Istanbul Hospital, Istanbul, 4Pulmonary Diseases Department, Adana Prof Dr Nusret Karasu Pulmonary Diseases Hospital, Adana, 5Pulmonary Diseases Department, Yedikule Pulmonary Diseases and Surgery Training and Research Hospital, Istanbul, 6Pulmonary Diseases Department, Nihat Kitapçi Pulmonary Diseases and Surgery Hospital, Erzurum, 7Pulmonary Diseases Department, Atatürk Pulmonary Diseases and Surgery Training and Research Hospital, Ankara, 8Department of Pulmonary Diseases, Dicle University School of Medicine, Diyarbakir, 9Pulmonary Diseases Department, Uskudar State Hospital, Istanbul, 10Pulmonary Diseases Department, Samsun Pulmonary Diseases and Thoracic Surgery Hospital, 11Pulmonary Diseases Department, Novartis Pharmaceuticals, Istanbul, TurkeyBackground: Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey.Objectives: To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists.Design: A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded.Results: Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II,14.7%; III,84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting β2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid.Conclusion: Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages.Keywords: adherence, COPD, Global initiative for chronic Obstructive Lung Disease guidelines, treatment approach, Turkey, overtreatment, inhaled corticosteroid

The purpose of this study was to assess whether different stages of chronic obstructive pulmonary disease (COPD) severity defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria correlate with meaningful differences in health status. A total of 381 COPD patients, aged 73+/-6 yrs, were classified in the five GOLD stages. Disease-specific (St George Respiratory Questionnaire (SGRQ)) and generic indexes of health status were measured in all patients. Multivariate analysis of covariance or Kruskal Wallis tests were used to compare health status indexes across the spectrum of GOLD stages of COPD severity. GOLD stages of COPD severity significantly differed in SGRQ components and Barthel's index, but not in the indexes assessing cognitive and affective status and quality of sleep. The largest variation in health status was observed at the transition from stage IIa to stage IIb, while there were no other significant differences between consecutive stages. Both female sex and comorbidity were associated with a greater impact of COPD on the health status. In conclusion, the upper limit of stage IIb (forced expiratory volume in one second of 49%) marks a threshold for dramatic worsening of health status. Progression of chronic obstructive pulmonary disease severity from stage 0 to stage IIa does not correspond to any meaningful difference in health status.