Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study

Int J Chron Obstruct Pulmon Dis. 2016 Jun 8:11:1217-22. doi: 10.2147/COPD.S100853. eCollection 2016.

Abstract

Introduction: Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline.

Methods: We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations.

Results: We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort.

Conclusion: A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative.

Keywords: COPD; algorithm; primary care; treatment.

Publication types

  • Comparative Study
  • Multicenter Study
  • Validation Study

MeSH terms

  • Administration, Inhalation
  • Aged
  • Algorithms*
  • Bronchodilator Agents / administration & dosage*
  • Clinical Decision-Making*
  • Cross-Sectional Studies
  • Decision Support Techniques*
  • Disease Progression
  • Dyspnea / classification
  • Dyspnea / diagnosis
  • Dyspnea / drug therapy*
  • Dyspnea / physiopathology
  • Female
  • Forced Expiratory Volume
  • Guideline Adherence
  • Humans
  • Lung / drug effects*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Patient Selection
  • Pilot Projects
  • Practice Guidelines as Topic*
  • Predictive Value of Tests
  • Primary Health Care
  • Pulmonary Disease, Chronic Obstructive / classification
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Reproducibility of Results
  • Severity of Illness Index
  • Spanien

Substances

  • Bronchodilator Agents