PMID- 22481636
OWN - NLM
STAT- MEDLINE
DCOM- 20120820
LR  - 20220409
IS  - 1424-3997 (Electronic)
IS  - 0036-7672 (Linking)
VI  - 142
DP  - 2012
TI  - Impact of adherence to the GOLD guidelines on symptom prevalence, lung function 
      decline and exacerbation rate in the Swiss COPD cohort.
PG  - w13567
LID - 10.4414/smw.2012.13567 [doi]
AB  - PRINCIPLES: 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. 
      METHODS: 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. RESULTS: 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 beta2-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. CONCLUSIONS: 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.
FAU - Jochmann, Anja
AU  - Jochmann A
AD  - Clinic of Internal Medicine, University Hospital of Basel, Switzerland.
FAU - Scherr, Andreas
AU  - Scherr A
FAU - Jochmann, Dirk Christian
AU  - Jochmann DC
FAU - Miedinger, David
AU  - Miedinger D
FAU - Torok, Salome Schafroth
AU  - Torok SS
FAU - Chhajed, Prashant N
AU  - Chhajed PN
FAU - Tamm, Michael
AU  - Tamm M
FAU - Leuppi, Jorg Daniel
AU  - Leuppi JD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120405
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Adrenergic beta-2 Receptor Agonists)
RN  - 0 (Bronchodilator Agents)
RN  - 0 (Cholinergic Antagonists)
SB  - IM
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Adrenergic beta-2 Receptor Agonists/therapeutic use
MH  - Aged
MH  - Aged, 80 and over
MH  - Bronchodilator Agents/therapeutic use
MH  - Cholinergic Antagonists/therapeutic use
MH  - Cough/etiology
MH  - *Disease Progression
MH  - Drug Therapy, Combination
MH  - Exercise
MH  - Female
MH  - General Practice
MH  - *Guideline Adherence
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Practice Guidelines as Topic
MH  - Pulmonary Disease, Chronic Obstructive/*diagnosis/physiopathology/*therapy
MH  - Severity of Illness Index
MH  - Smoking
MH  - Spirometry
MH  - Sputum/metabolism
MH  - Surveys and Questionnaires
MH  - Switzerland
MH  - Treatment Outcome
EDAT- 2012/04/07 06:00
MHDA- 2012/08/21 06:00
CRDT- 2012/04/07 06:00
PHST- 2012/04/07 06:00 [entrez]
PHST- 2012/04/07 06:00 [pubmed]
PHST- 2012/08/21 06:00 [medline]
AID - smw-13567 [pii]
AID - 10.4414/smw.2012.13567 [doi]
PST - epublish
SO  - Swiss Med Wkly. 2012 Apr 5;142:w13567. doi: 10.4414/smw.2012.13567. eCollection 
      2012.