Glaab T, Banik N, Singer C, Wencker M
Medizinischer Fachbereich Pneumologie, München.
Dtsch Med Wochenschr. 2006 May 26;131(21):1203-8. doi: 10.1055/s-2006-941752.
Primary care physicians (PCPs) are the ones mainly responsible for the initial diagnosis and outpatient care of patients with COPD. The aim of the present survey was to investigate their initial management of COPD in Germany based on current guidelines and to identify any deviations.
A prospective cross-sectional survey was conducted as a multiple-choice questionnaire sent out to 1836 PCPs in seven Federal States of Germany (one large town and surrounding country in each). The product-neutral questions focused on the key aspects of current national and international (GLOBAL) COPD guidelines.
486 physicians participated in the study (response rate 26.5%). 66.5% of the physicians used the German COPD guidelines, 20.8% used GOLD guidelines, and only 11.7% observed no guidelines. The physicians were aware of the epidemiological and public health significance of COPD. 76.5% saw spirometry as the diagnostic standard: it was available in 90.1% of the practices. However, only 60-65% were able to cite the correct spirometric criteria for classifying severity of the disease. Educational measures to help patients quit smoking and the teaching and monitoring of patients' inhalation technique were inadequately implemented. The two most important therapeutic goals cited were to improve quality of life (69.1%) and prevent exacerbations (53.1%). Except for the criteria for the use of steroids and the implementation of pulmonary rehabilitation measures, treatment of COPD based on severity class was largely in compliance with the guidelines. However, a significant percentage of the physicians incorrectly assessed the evidence-based clinical benefits of various therapeutic measures.
The study shows that, despite the high regard in which COPD guidelines are held, deficiencies exist with regard to the diagnosis and treatment of COPD and the practical implementation of educational measures.
基层医疗医生（PCP）主要负责慢性阻塞性肺疾病（COPD）患者的初始诊断和门诊治疗。本次调查旨在根据现行指南研究德国基层医疗医生对COPD的初始管理情况，并找出任何偏差。
开展一项前瞻性横断面调查，以多项选择题问卷的形式发送给德国七个联邦州的1836名基层医疗医生（每个州一个大城镇及周边乡村）。这些与产品无关的问题聚焦于当前国家和国际（全球）COPD指南的关键方面。
486名医生参与了该研究（应答率为26.5%）。66.5%的医生使用德国COPD指南，20.8%使用全球慢性阻塞性肺疾病倡议（GOLD）指南，仅有11.7%的医生未遵循任何指南。医生们知晓COPD的流行病学和公共卫生意义。76.5%的医生将肺功能测定视为诊断标准：90.1%的诊所具备该设备。然而，只有60 - 65%的医生能够引用正确的肺功能测定标准来对疾病严重程度进行分类。帮助患者戒烟的教育措施以及对患者吸入技术的指导和监测实施不足。提及的两个最重要的治疗目标是改善生活质量（69.1%）和预防病情加重（53.1%）。除了使用类固醇的标准和肺康复措施的实施情况外，基于严重程度分级的COPD治疗在很大程度上符合指南。然而，相当比例的医生错误评估了各种治疗措施基于证据的临床益处。
该研究表明，尽管COPD指南备受重视，但在COPD的诊断和治疗以及教育措施的实际实施方面仍存在不足。
