Chest Specialists versus Non-Specialists following International COPD Recommendations in Real-World Clinical Practice
Keywords:
Adherence, Clinical characteristics, COPD, GOLD recommendation, OutcomesAbstract
Introduction: Real-world clinical practice for management of chronic obstructive pulmonary disease (COPD) differs from international guidelines by the Global Initiative for Chronic Obstructive Lung Disease and this affects clinical outcomes.
Objectives: To determine rates of following the guidelines and the impact on the clinical outcomes in COPD patients.
Methods: A prospective study was conducted in 2 outpatient clinics at a University Hospital in Thailand. Demographics and clinical data were collected. Chest specialist (CS) and non-CS groups were compared in clinical data.
Results: One hundred forty-five patients (87.6% male) were included. Of these, 81 (55.9%) were followed up at a CS outpatient department. The overall prevalence of COPD management following guidelines was 29.0% (27.2% in the CS group and 31.3% in the non-CS group, P=0.590). Compared to the non-CS group, the CS group had higher proportions of chronic kidney disease (21.0% vs 7.8%, P=0.028), coronary heart disease (35.8% vs 15.6%, P=0.007), and modified Medical Research Council scores (1.9±1.1 vs 1.5±1.2, P=0.038). The CS group also had higher rates of vaccinations and pulse oximetry measurement than the non-CS group. There were no differences in pulmonary functions or exacerbation and hospitalization rates between the two groups.
Conclusions: One-third of patients were managed following the COPD guidelines in real-world practice. The rates of following the guidelines did not significantly differ between the CS and the non-CS groups. This finding may explain the similar clinical outcomes. Nevertheless, a large prospective study is required to compare clinical outcomes between the two groups.
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