Clinic of Internal Medicine, University Hospital of Basel, Switzerland.
Swiss Med Wkly. 2012 Apr 5;142:w13567. doi: 10.4414/smw.2012.13567. eCollection 2012.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines aim to optimise chronic obstructive pulmonary disease (COPD) diagnosis and treatment. However, little is known about the extent to which general practitioners' (GP) adherence to GOLD guidelines improves patient outcomes.
In this questionnaire-based study, COPD patients were screened and enrolled; exacerbation history was recorded, and demographic, spirometric and management data were collected for 12 months. Spirometry was performed at least every 6 months according to American Thoracic Society guidelines. Based on these data, patients were grouped into GOLD COPD severity classifications. Data were expressed as the difference between baseline and month 12.
Among 139 GPs, 454 patients were analysed regarding baseline and 12 month data. There was no significant change in distribution of GOLD COPD severity grades, lung function or guideline adherence. Chronic cough and sputum production were significantly reduced (p <0.001; p <0.020), as was exacerbation rate (p = 0.041). Factors associated with exacerbations were male sex, asthma and cerebrovascular insult as a co-morbidity. Exacerbation rate was significantly reduced in patients treated with combination therapy (long-acting β2-agonist (LABA)+ inhaled corticosteroids (ICS); p = 0.0178) and long-acting anticholinergics (LAAC; p = 0.0011). Patients treated per guidelines had no advantage in lung function, estimation of symptom prevalence or, most importantly, exacerbation rate.
While there was no improvement in adherence to GOLD guidelines, disease severity was not affected detrimentally, suggesting that guideline adherence does not seem to impact symptom prevalence, exacerbation rate or lung function decline after one year of follow up.
慢性阻塞性肺疾病全球倡议（GOLD）指南旨在优化慢性阻塞性肺疾病（COPD）的诊断和治疗。然而，对于全科医生（GP）遵循 GOLD 指南是否能改善患者预后，我们知之甚少。
在这项基于问卷调查的研究中，筛选并纳入了 COPD 患者；记录了加重病史，并收集了 12 个月的人口统计学、肺功能和管理数据。根据美国胸科学会指南，每 6 个月至少进行一次肺功能检查。根据这些数据，患者被分为 GOLD COPD 严重程度分类。数据表示为基线和第 12 个月的差异。
在 139 名全科医生中，有 454 名患者分析了基线和 12 个月的数据。GOLD COPD 严重程度分级、肺功能或指南遵循情况的分布没有显著变化。慢性咳嗽和咳痰显著减少（p<0.001；p<0.020），加重率也降低（p=0.041）。与加重相关的因素包括男性、哮喘和脑血管意外作为合并症。接受联合治疗（长效β2-激动剂（LABA）+吸入皮质激素（ICS）；p=0.0178）和长效抗胆碱能药物（LAAC；p=0.0011）的患者，加重率显著降低。按照指南治疗的患者在肺功能、症状流行率的估计或最重要的是加重率方面没有优势。
尽管对 GOLD 指南的遵循没有改善，但疾病严重程度没有受到不利影响，这表明在一年的随访后，遵循指南似乎不会影响症状流行率、加重率或肺功能下降。
