Adherence to Current COPD Guidelines in Turkey

Turan, Onur; Emre, Jülide Çeldir; Deniz, Serdar; Baysak, Ayşegül; Turan, Pakize Ayşe; Mirici, Arzu

doi:10.1517/14656566.2016.1115482

Cited by 20 publications

(34 citation statements)

References 17 publications

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“… 22 , 26 – 28 The main reason for guideline nonadherence in the current study was due to overtreatment, especially the overuse of ICS in low-risk patients alone or in combination with other BDs, which had also been reported in a Turkish study. 22 Long-acting BDs were indicated for group B patients, but they were underutilized. More than 65% of group B patients received LABA/ICS combination, but only a minor proportion of them received single or combined long-acting BDs.…”

Section: Discussionsupporting

confidence: 64%

“…The baseline patient characteristics were comparable with other local and international COPD studies, which comprised mainly male heavy smokers, with similar body mass index (BMI) and forced expiratory volume in 1 second (FEV 1 ) levels. 18 , 22 – 24 The spectrum of COPD included patients of groups A–D, with a distribution skewed toward the categories with more symptoms (groups B and D) with relatively high mMRC and CAT scores. This finding is different from the data obtained in the EPIC Asia population-based study, which was mainly a cross-sectional population-based survey.…”

Section: Discussionmentioning

confidence: 99%

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Adherence to a COPD treatment guideline among patients in Hong Kong

Chan

et al. 2017

COPD

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BackgroundThis study aimed to assess the adherence rate of pharmacological treatment to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline published in 2011 and the prevalence of comorbidities among patients with COPD in Hong Kong (HK).MethodsPatients were recruited from five tertiary respiratory centers and followed up for 12 months. Data on baseline physiological, spirometric parameters, use of COPD medications and coexisting comorbidities were collected. The relationship between guideline adherence rate and subsequent COPD exacerbations was assessed.ResultsAltogether, 450 patients were recruited. The mean age was 73.7±8.5 years, and 92.2% of them were males. Approximately 95% of them were ever-smokers, and the mean post-bronchodilator (BD) forced expiratory volume in 1 second was 50.8%±21.7% predicted. The mean COPD Assessment Test and modified Medical Research Council Dyspnea Scale were 13.2±8.1 and 2.1±1.0, respectively. In all, five (1.1%), 164 (36.4%), eight (1.8%) and 273 (60.7%) patients belonged to COPD groups A, B, C and D, respectively. The guideline adherence rate for pharmacological treatment ranged from 47.7% to 58.1% in the three clinic visits over 12 months, with overprescription of inhaled corticosteroids (ICS) and underutilization of long-acting BDs in group B COPD patients. Guideline nonadherence was not associated with increased risk of exacerbation after adjustment of confounding variables. However, this study was not powered to assess a difference in exacerbations. In all, 80.9% of patients had at least one comorbidity.ConclusionA suboptimal adherence to GOLD guideline 2011, with overprescription of ICS, was identified. The commonly found comorbidities also aligned with the trend observed in other observational cohorts.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Adherence to a COPD treatment guideline among patients in Hong Kong

Chan

et al. 2017

COPD

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“… 11 In another study from Turkey, adherence to guideline recommendations for COPD patients was found to be 48.2%. 12 In the present study as well, the rate of guideline-concordant diagnosis among physicians who used appropriate PFT was 38% in Case GOLD A-smoker, while the rates increased to 74%, 78%, 80%, and 82% in Case GOLD A-nonsmoker, Case GOLD D-smoker, Case GOLD B-exsmoker, and Case GOLD B-smoker, respectively. However, even if the guideline-concordant diagnosis of COPD was performed, only a minority (10%–24%) of the physicians used the GOLD classification.…”

Section: Discussionsupporting

confidence: 64%

A case scenario study for the assessment of physician’s behavior in the management of COPD: the WHY study

Kılınç

Konya

Akgün

et al. 2018

COPD

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PurposeCOPD diagnosis is mainly based on clinical judgment of physicians. Physicians do not also refer to COPD guidelines in their daily practice. This study aimed to assess attitudes of physicians regarding COPD diagnosis, treatment, and follow-up and to identify the factors influencing physicians’ decisions in clinical practice.Patients and methodsFifty physicians were selected from 12 EuroStat NUTS 2 regions and asked to assess seven fictitious case scenarios. The following five scenarios described patients with COPD: Case Global Initiative for Chronic Obstructive Lung Disease (GOLD) A-smoker and Case GOLD A-nonsmoker were previously undiagnosed patients presenting with dyspnea, Case GOLD D-smoker and GOLD B-exsmoker were COPD patients presenting with exacerbation, Case GOLD B-smoker was a previously diagnosed COPD patient with dyspnea in stable phase, Case asthma–COPD overlap syndrome, and Case obesity hypoventilation syndrome. Patients’ history, physical examination findings, pulmonary function tests, and X-ray images were prepared before the study by an experts’ committee and provided to the physicians upon their request, until they reached a final decision. The physicians completed a questionnaire including information about their clinical practices and institutions.ResultsAccording to the GOLD 2015 recommendations, of the physicians, 44% performed guideline-concordant diagnosis in the first five scenarios, who were all COPD patients, and 6% performed guideline-concordant diagnosis in all cases. There was a negative correlation between high workload and making a guideline-concordant diagnosis (P=0.038, rho =−0.417). Even when the physicians made a guideline-concordant diagnosis of COPD, only a minority (10%–22%) used the GOLD classification. Logistic regression analysis revealed that working in a tertiary health care center was a significant factor in favor of establishing a guideline-concordant diagnosis of COPD (P=0.029, OR =6.139 [95% CI: 1.20–31.32]).ConclusionManagement of COPD patients in Turkey does not generally follow the GOLD criteria but is rather based on physicians’ clinical experience. Heavy workload appears to adversely affect the correctness of clinical decisions.

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“…The use of appropriate treatment according to the guidelines not only improves spirometric measurements, but also reduces treatment costs and even mortality (2). Overtreatment in COPD is reported to cause a huge cost burden (17,22). Both appropriate treatment according to the guidelines and a de-escalation of overtreatment led to significant cost savings in the present study, however a long-term follow up is needed to identify the effects of this intervention on mortality.…”

Section: Discussionmentioning

confidence: 64%

“…In the present study, 44% of the patients were under appropriate treatment according to the guidelines, which was similar to the findings of previous literature. Studies from foreign countries reported that one-third to two-thirds of COPD patients were under appropriate treatment according to the guidelines (5,6), while studies in Turkey reported that nearly half of all COPD patients are under appropriate treatment (7,17).…”

Section: Discussionmentioning

confidence: 99%

Modifications in COPD Treatment According to GOLD Guideline Recommendations

Turan

Şahin

Altunbey³

et al. 2020

Preprint

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INTRODUCTION Polypharmacy of respiratory medications is commonly seen in COPD patients. Reduction of COPD therapy in patients with overtreatment may have benefits by providing adherence to the guideline recommendations. We aimed to investigate effects of treatment de-escalation in COPD. METHODS This multi-center, prospective study was carried out in four pulmonary outpatient clinics. Overtreated patients (according to GOLD 2017) were recommended to undergo de-escalation of treatment (reduction group I), and those who were under appropriate treatment were recommended a stepwise de-escalation (reduction group II). Patients who declined de-escalation were in non-reduction group I. Non-reduction group II consisted of patients under appropriate treatment. Inhalation device skill, symptom control and quality of life (QOL) were assessed at baseline and 6-month follow-up. RESULTS At baseline visit, 55.9% of participants (76/136) were overtreated. There were de-escalation in 54 patients (35: reduction group I, 19: reduction group II). Non- reduction groups I and II included 37 and 45 patients, respectively. FEV 1 of patients with appropriate treatment improved significantly (p=0.033). There was a significant improvement in QOL in reduction group I (p=0.005) and II (p=0.011). Patients who reduced/quitted smoking during follow-up recorded significant improvements in FEV 1 and drug inhalation skills score (p=0.034 and p=0.023, respectively). Overtreatment had an estimated additional cost of 119.57$/year for each patient. CONCLUSION Overtreatment is a common problem in COPD. De-escalation of inhaler medications can improve QOL. Appropriate treatment according to guidelines positively affects respiratory parameters. Reduction/discontinuation of smoking improves both inhaler adherence and spirometric measurements. De-escalation of inhaler treatment should be considered in overtreated patients.

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Adherence to Current COPD Guidelines in Turkey

Cited by 20 publications

References 17 publications

Adherence to a COPD treatment guideline among patients in Hong Kong

Adherence to a COPD treatment guideline among patients in Hong Kong

A case scenario study for the assessment of physician’s behavior in the management of COPD: the WHY study

Modifications in COPD Treatment According to GOLD Guideline Recommendations

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Adherence to Current COPD Guidelines in Turkey

Cited by 20 publications

References 17 publications

Adherence to a COPD treatment guideline among patients in Hong Kong

Adherence to a COPD treatment guideline among patients in Hong Kong

A case scenario study for the assessment of physician&rsquo;s behavior in the management of COPD: the WHY study

Modifications in COPD Treatment According to GOLD Guideline Recommendations

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Product

Resources

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A case scenario study for the assessment of physician’s behavior in the management of COPD: the WHY study