Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education

Abstract

BackgroundSymptoms of COPD are frequently disregarded by patients and also by general practitioners (GPs) in early stages of the disease, that consequently is diagnosed when already at an advanced grade of severity. Underdiagnosis and undertreatment of COPD and scarce use of spirometry are widely recurrent, while a better knowledge of the disease and a wider use of spirometry would be critical to diagnose more patients still neglected, do it at an earlier stage and properly treat established COPD. The aim of Pneumocafè project is to improve, through an innovative approach, the diagnosis and management of COPD at primary care level increasing the awareness of issues pertaining to early diagnosis, adequate prevention and correct treatment of the disease.MethodsPneumocafè is based on informal meetings between GPs of various geographical zones of Italy and their reference respiratory specialist (RS), aimed at discussing the current practice in comparison to suggestions of official guidelines, analyzing the actual problems in diagnosing and managing COPD patients and sharing the possible solution at the community level. In these meetings RSs faced many issues including patho-physiological mechanisms of bronchial obstruction, significance of clinical symptoms, patients’ phenotyping, and clinical approach to diagnosis and long-term treatment, also reinforcing the importance of a timely diagnosis, proper long term treatment and the compliance to treatment. At the end of each meeting GPs had to fill in a questionnaire arranged by the scientific board of the Project that included 18 multiple-choice questions concerning their approach to COPD management. The results of the analysis of these questionnaires are here presented.Results1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis. The 49 RSs, 37 males and 12 females, were distributed all over the Italian country and practiced their profession both in public and private hospitals and in territorial sanitary facilities. GPs were 1,330 males (71.35%) and 534 females (28.64%), mean age 56,29 years (range 27-70 yrs). Mean duration of general practice was 25.56 years (range: 0,5-40 yrs) with a mean of 1,302.43 patients assisted by each GP and 2,427,741 patients assisted in all. The majority of GPs affirmed that in their patients COPD has a mean-to-great prevalence and a mean/high impact on their practice, preceded only by diabetes and heart failure. Three-quarters of GPs refer to COPD guidelines and most of them believe that a screening on their assisted patients at risk would enhance early diagnosis of COPD. Tobacco smoking is the main recognized cause of COPD but the actions carried out by GPs to help a patient to give up smoking result still insufficient. The majority of GPs recognize spirometry as necessary to early COPD diagnosis, but the main obstacle pointed out to its wider use was the too long time for the spirometry to be performed. GPs’...

COPD and Public Opinion: Results of a Survey in the General Population

“…Also the knowledge on COPD confirmed poor. Actually, even if a proportion of respondents claimed to be aware of the dangerous role of cigarette smoke (which in the present survey was regarded as the most relevant risk factor for COPD, as well as in other studies [8,19,24]), another relevant proportion of respondents claimed their firm belief that COPD is uniquely induced by ageing, even if they regarded COPD as a "rare disease", having this convincement been affirmed independently of their awareness of the wide diffusion of smoking habit. Moreover, a further set of respondents proved astonishingly convinced that COPD represents a pathological condition which is easily and definitively curable by means of a short-term antibiotic course: obviously, COPD does not represent a problem for the public welfare at all in their opinion.…”

“…Although the concept of "public awareness" has been increasingly evoked for COPD [10,[13][14][15][16], true investigations oriented to its quantitative assessment within the public opinion still are episodic [17][18][19], or absent in our country. The aim of the present study was to investigate the knowledge and the awareness of COPD in the Italian general population.…”

Standards of suitability for the management of chronic obstructive respiratory diseases

“…GOLD guidelines diffusion started more than one decade ago and since not long ago they were the only ones known in Italy, thus it is not surprising that the greatest majority of physicians refer to them. This is confirmed by another multicentric survey among general practitioners [ 77 ] where 62% declared they refer to GOLD guidelines and only 16% to institutional national guidelines, while 22% do not use guidelines at all. In the last two years, however, both specialists and general practitioners began to use institutional guidelines more and more, also because these guidelines have been drawn up through a collaboration of different medical and non-medical components involved in respiratory assistance.…”

Enhancing the diagnosis and management of COPD in Primary care

“…In the article recently published in Multidisciplinary Respiratory Medicine [ 3 ] Sanguinetti and colleagues [ 3 ] report a nationwide study of this and related issues and whilst highlighting an appreciation of the role of spirometry in specialist and General Practice they report on the latters concern re difficulty in accessing spirometry and other barriers to implementation. This by itself is not new and others have demonstrated how easier access to well conducted spirometry can reveal how clinical impressions are insufficient to make a diagnosis and mistakenly lead to those with no evidence of airway narrowing receiving often expensive bronchodilators [ 4 ].…”

“…Even within a large clinical trial when those with COPD knew that their use of therapy was being monitored a fifth of patients did not take medicine as previously discussed with the doctor with one trial showing a significantly deleterious effect of this behaviour on hospitalisation rates and upon mortality [ 7 ]. The Pneumocafé project [ 3 ] represents a further way of demonstrating the importance of this subject to primary care physicians.…”