Kim Tae-Ok, Shin Hong-Joon, Kim Yu-Il, Rhee Chin-Kook, Lee Won-Yeon, Lim Seong-Yong, Ra Seung-Won, Jung Ki-Suck, Yoo Kwang-Ha, Park Seoung-Ju, Lim Sung-Chul
Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
Chonnam Med J. 2019 Jan;55(1):47-53. doi: 10.4068/cmj.2019.55.1.47. Epub 2019 Jan 25.
The guidelines for chronic obstructive pulmonary disease (COPD) treatment are important for the management of the disease. However, studies regarding the treatment adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been scarce in Korea. Therefore, to examine the adherence to the GOLD guidelines, we examined the patterns of prescribed medication in COPD patients from 2011 to 2018. Patients were classified as having been appropriately and inappropriately treated (overtreatment or undertreatment) for the GOLD group. Appropriate medical therapy was defined as using the first choice or alternative choice drug recommended in the GOLD guidelines. Inappropriate therapy was classified as overtreatment or undertreatment in accordance with the categorization in the GOLD guidelines. According to treatment of 2011 GOLD guidelines, there was inappropriate treatment in 52.3% in group A, 47.3% in group B, 56.3% in group C, and 17.8% in group D. According to treatment of 2017 GOLD guidelines, there was inappropriate treatment in 66.7% in group A, 45.3% in group B, 14.3% in group C, and 24.0% in group D. The common type of inappropriate COPD treatment is overtreatment, with inhaled corticosteroid (ICS) containing regimens. In conclusions, adherence to the GOLD guideline by the pulmonologist in clinical practice is still low in Korea. Therefore, we need better strategies to both optimize the use of the guidelines and adhere to the guidelines as well.
慢性阻塞性肺疾病（COPD）的治疗指南对于该疾病的管理至关重要。然而，在韩国，关于遵循慢性阻塞性肺疾病全球倡议组织（GOLD）指南进行治疗的研究却很少。因此，为了检验对GOLD指南的遵循情况，我们研究了2011年至2018年COPD患者的药物处方模式。患者被分为在GOLD组中接受了适当治疗和不适当治疗（过度治疗或治疗不足）。适当的药物治疗被定义为使用GOLD指南中推荐的首选或替代药物。不适当的治疗根据GOLD指南中的分类被归类为过度治疗或治疗不足。根据2011年GOLD指南的治疗情况，A组中52.3%存在不适当治疗，B组中47.3%，C组中56.3%，D组中17.8%。根据2017年GOLD指南的治疗情况，A组中66.7%存在不适当治疗，B组中45.3%，C组中14.3%，D组中24.0%。COPD不适当治疗的常见类型是过度治疗，采用含吸入性糖皮质激素（ICS）的治疗方案。总之，在韩国，临床实践中肺科医生对GOLD指南的遵循率仍然很低。因此，我们需要更好的策略来优化指南的使用并同时遵循指南。
