The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Abstract

BackgroundThis nationwide study was performed to evaluate the evolution of distributions of patients with COPD according to the 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and to assess the concordance between the prescribed medications and the pharmacological management recommended by the two distinct classification systems in Taiwan.Subjects and methodsData were retrospectively retrieved from stable COPD patients in 11 participating hospitals across Taiwan. Patients were grouped according to GOLD 2011 and 2017 guidelines respectively. Definitions of undertreatment and overtreatment were based on the pharmacological recommendations in the individual guidelines.ResultsA total of 1,053 COPD patients were included. The percentages of patients in GOLD 2011 groups A, B, C and D were 18.4%, 40.6%, 6.7% and 34.2%, respectively. When reclassified according to the GOLD 2017, the percentages of group A and B increased to 23.3% and 63.2%, and groups C and D decreased to 1.9% and 11.6%, respectively. Up to 67% of patients in GOLD 2011 groups C and D were reclassified to GOLD 2017 groups A and B. The pharmacological concordance rate was 60.9% for GOLD 2011 and decreased to 44.9% for GOLD 2017. Overtreatment was found in 29.5% of patients according to GOLD 2011 and the rate increased to 46.1% when classified by the GOLD 2017. The major cause of overtreatment was unnecessary inhaled corticosteroids and the main cause of undertreatment was a lack of maintenance long-acting bronchodilators.ConclusionThe distribution of COPD patients in Taiwan was more uneven with the GOLD 2017 than with the GOLD 2011. A pharmacological discordance to the guidelines was identified. Updated guidelines with reclassification of COPD patients resulted in more discordance between prescribed medications and the guidelines. Physicians should make proper adjustments of the prescriptions according to the updated guidelines to ensure the mostly appropriate treatment for COPD patients.

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD)

“…The adherence rate was almost three times higher in patients classified A/B GOLD groups when compared to those classified C/D (Table 5). This finding is partially in line with those reported in some related studies [6,9,13] (Appendix A). First, after adjusting for age, sex, smoking habits, number of exacerbations, control of symptoms, and health service use, Maio et al [6] showed that group D patients, compared to the ones in group A, are significant protective factors for the lack of prescriptive appropriateness (OR: 0.05).…”

“…Yet, the Tunisian pulmonologists' adherence rates were intermediate compared to those reported in similar studies (Table 1S). The adherence rates varied from 0.2 [43] to 61.5% [16] in group A, from 0.2 [43] to 43.9% [9] in group B, from 0.0 [43] to 81.5% [10] in group C, and from 4.6 [10] to 96.2% [41] in group D. To summarize, COPD patients continue to be treated in the wrong way, signifying that the GOLD PTGs are not being completely utilized [13]. This frequent pattern is not specific to the developing countries, but it is rather an international issue (Table 1S).…”

Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve

“…Of these, the 2017 revision had particular importance because it refined the previous ABCD assessment considering patient symptoms [ 5 , 6 ], combined with the history of exacerbations, excluding spirometry grading and modifying the pharmacological recommendations [ 1 ]. Although the COPD guidelines are important for the management of the disease [ 4 ], in a number of countries, low levels of adherence to the guideline recommendations were recorded among doctors treating different patient cohorts [ 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], often with overtreatment with inhaled corticosteroids (ICS) [ 13 ]. According to the World Health Organization (WHO) [ 15 ], factors influencing pulmonologist adherence to the guidelines are very complex, related not only to the physician, but also to the patient, disease, and/or social aspects [ 14 , 16 ].…”

The Many Faces of Chronic Obstructive Pulmonary Disease: Moving Towards Precision Medicine

“…Also, the evolvement of the GOLD recommendations over the years mirrors the evolvement of our understanding of the disease. Before the 2011 update of the GOLD recommendations, therapy recommendations were based primarily on lung-function values 53 . Current treatment recommendations are based on a combination of lung function, symptoms and number of exacerbations in the previous year.…”