The Clinical Respiratory Journal
ORIGINAL ARTICLE
Adherence to the Global Initiative for Chronic Obstructive Lung Disease guidelines for management of COPD: a hospital-base study Seyed Masoom Masoompour1, Abbas Mohammadi2 and Hamideh Mahdaviazad3 1 Internal Medicine Department, Shiraz University of Medical Sciences, Shiraz, Iran 2 Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 3 Social Determinants of Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract Background and Aims: To determine the level of adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, we compared our inpatient management of exacerbations of chronic obstructive pulmonary disease (COPD) to these guidelines. Method: This cross-sectional descriptive study was conducted from January 2011 to April 2012 in a 360-bed teaching hospital in Shiraz, Iran. We recorded the management data for 96 consecutive patients with COPD exacerbation. SPSS 11.5 software (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses. Results: The mean (standard deviation) age of our patients was 67.3 (14) years, and more than 75% of them were men. Adherence for starting antibiotics was 84.4%. Most of our patients (82.3%) received oxygen therapy, for a level of adherence to GOLD recommendations of 74%. Nearly 95% received a short-acting bronchodilator, and 12.5% received a long-acting bronchodilator. Adherence to the guidelines was 19.8% for oral and 61.4% for inhaled steroids. Adherence to the guidelines was 49% for starting N-acetylcysteine, 77.1% for antitussives and 13.5% for xanthine derivatives (aminophylline and theophylline). The overall adherence to GOLD guidelines was 67.2% at our hospital. Conclusion: The level of adherence to GOLD guidelines for the management of COPD exacerbation was suboptimal at our teaching hospital. Further improvements in adherence to these guidelines are needed. Please cite this paper as: Masoompour SM, Mohammadi A and Mahdaviazad H. Adherence to the Global Initiative for Chronic Obstructive Lung Disease guidelines for management of COPD: a hospital-base study. Clin Respir J 2014; ••: ••–••. DOI:10.1111/crj.12215.
Key words chronic obstructive pulmonary disease – clinical guidelines – evaluation – exacerbation – management Correspondence Hamideh Mahdaviazad, MD, Social Determinants of Health Research Center, Shiraz University of Medical Sciences, P.O. Box: 7193634154, Shiraz, Iran. Tel: +98-711-6474316 Fax: +98-711-6474316 email: [email protected] Received: 28 May 2014 Revision requested: 13 August 2014 Accepted: 29 September 2014 DOI:10.1111/crj.12215 Authorship and contributorship SM Masoompour contributed to the design of the study, critical revision of the content and final approval of the article. A Mohammadi contributed to data acquisition, drafting the article and final approval of the article. H Mahdaviazad contributed to the conception and design of the study and the analysis and interpretation of data, drafting the article and final approval of the article. Ethics The regional ethical review board of Shiraz University of Medical Sciences approved the study. The patients were informed of the nature and purpose of the study and oral informed consent was obtained. Conflict of interest The authors do not have any potential conflicts of interest.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
1
Adherence to the GOLD guidelines for COPD
Introduction Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease. It is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gasses (1, 2). COPD is the fourth leading cause of morbidity and mortality in the world. In different countries, the prevalence of COPD varies from 0.2% to 18.3% (3, 4). To achieve the main goal of COPD treatment, i.e. reducing symptoms, preventing exacerbation and increasing quality of life and exercise capacity, a group of experts in combination with the World Health Organization and the National Heart, Lung and Blood Institute issued the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 1997 (5, 6). Adherence to GOLD guidelines for standard diagnosis and treatment varies throughout the world (5, 7, 8). Sarc et al. found suboptimal implementation of the treatment guidelines in 1185 patients hospitalized because of COPD (9). Cydulka et al. reported low adherence to the guidelines in managing acute exacerbations of COPD: 38% of patients did not receive a systemic corticosteroid, and 72% were not given antibiotics (10). A cross-sectional survey of 833 patients with COPD showed that treatment with short-acting bronchodilators was prescribed in a range of 21.1%– 90.1% of the patients. Combined therapy with a longacting bronchodilator and inhaled corticosteroids was used in 45.9% of patients. Up to 27.8% of those with an indication for treatment with inhaled corticosteroids did not receive these drugs (11). In Iran, there are no local standard guidelines for managing COPD, and to the best of our knowledge no studies to date have evaluated physicians’ adherence to the international GOLD guidelines. We designed this study to determine the level of adherence to GOLD guidelines for the inpatient treatment of COPD exacerbations at our hospital.
Materials and methods Research design A cross-sectional descriptive design was used in this research.
Study setting The study was conducted from January 2011 to April 2012 in the medical emergency department of Shahid
2
Masoompour et al.
Faghihi Hospital in the city of Shiraz, the capital of Fars province, Iran. This public teaching hospital has 360 active beds and is a referral center for southern Iran.
Participants and data collection tool During January 2011 to April 2012, we included all consecutive patients admitted to our hospital because of an exacerbation of COPD. All patients had physician-diagnosed COPD. Patients were excluded if they were discharged or died within 24 h of admission. After permission was obtained to visit the patients and access their charts, a trained researcher (A. M.) interviewed each patient and extracted data from his or her medical record with a specially designed datagathering form. The form contained two parts: the first part included general characteristics of patients such as age, gender, number of days since admission and final outcome, and the second part contained treatment data. Adherence was measured by reviewing the patients’ data for 11 major components of treatment (Table 1) and comparing them with the GOLD guidelines.
Statistical analysis Continuous variables are presented as mean values (±standard deviation, SD). Categorical variables are presented as absolute numbers and percentages. SPSS 11.5 software (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses. The differences were considered statistically significant at a P value
ORIGINAL ARTICLE
Adherence to the Global Initiative for Chronic Obstructive Lung Disease guidelines for management of COPD: a hospital-base study Seyed Masoom Masoompour1, Abbas Mohammadi2 and Hamideh Mahdaviazad3 1 Internal Medicine Department, Shiraz University of Medical Sciences, Shiraz, Iran 2 Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 3 Social Determinants of Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract Background and Aims: To determine the level of adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, we compared our inpatient management of exacerbations of chronic obstructive pulmonary disease (COPD) to these guidelines. Method: This cross-sectional descriptive study was conducted from January 2011 to April 2012 in a 360-bed teaching hospital in Shiraz, Iran. We recorded the management data for 96 consecutive patients with COPD exacerbation. SPSS 11.5 software (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses. Results: The mean (standard deviation) age of our patients was 67.3 (14) years, and more than 75% of them were men. Adherence for starting antibiotics was 84.4%. Most of our patients (82.3%) received oxygen therapy, for a level of adherence to GOLD recommendations of 74%. Nearly 95% received a short-acting bronchodilator, and 12.5% received a long-acting bronchodilator. Adherence to the guidelines was 19.8% for oral and 61.4% for inhaled steroids. Adherence to the guidelines was 49% for starting N-acetylcysteine, 77.1% for antitussives and 13.5% for xanthine derivatives (aminophylline and theophylline). The overall adherence to GOLD guidelines was 67.2% at our hospital. Conclusion: The level of adherence to GOLD guidelines for the management of COPD exacerbation was suboptimal at our teaching hospital. Further improvements in adherence to these guidelines are needed. Please cite this paper as: Masoompour SM, Mohammadi A and Mahdaviazad H. Adherence to the Global Initiative for Chronic Obstructive Lung Disease guidelines for management of COPD: a hospital-base study. Clin Respir J 2014; ••: ••–••. DOI:10.1111/crj.12215.
Key words chronic obstructive pulmonary disease – clinical guidelines – evaluation – exacerbation – management Correspondence Hamideh Mahdaviazad, MD, Social Determinants of Health Research Center, Shiraz University of Medical Sciences, P.O. Box: 7193634154, Shiraz, Iran. Tel: +98-711-6474316 Fax: +98-711-6474316 email: [email protected] Received: 28 May 2014 Revision requested: 13 August 2014 Accepted: 29 September 2014 DOI:10.1111/crj.12215 Authorship and contributorship SM Masoompour contributed to the design of the study, critical revision of the content and final approval of the article. A Mohammadi contributed to data acquisition, drafting the article and final approval of the article. H Mahdaviazad contributed to the conception and design of the study and the analysis and interpretation of data, drafting the article and final approval of the article. Ethics The regional ethical review board of Shiraz University of Medical Sciences approved the study. The patients were informed of the nature and purpose of the study and oral informed consent was obtained. Conflict of interest The authors do not have any potential conflicts of interest.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2014 John Wiley & Sons Ltd
1
Adherence to the GOLD guidelines for COPD
Introduction Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease. It is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gasses (1, 2). COPD is the fourth leading cause of morbidity and mortality in the world. In different countries, the prevalence of COPD varies from 0.2% to 18.3% (3, 4). To achieve the main goal of COPD treatment, i.e. reducing symptoms, preventing exacerbation and increasing quality of life and exercise capacity, a group of experts in combination with the World Health Organization and the National Heart, Lung and Blood Institute issued the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 1997 (5, 6). Adherence to GOLD guidelines for standard diagnosis and treatment varies throughout the world (5, 7, 8). Sarc et al. found suboptimal implementation of the treatment guidelines in 1185 patients hospitalized because of COPD (9). Cydulka et al. reported low adherence to the guidelines in managing acute exacerbations of COPD: 38% of patients did not receive a systemic corticosteroid, and 72% were not given antibiotics (10). A cross-sectional survey of 833 patients with COPD showed that treatment with short-acting bronchodilators was prescribed in a range of 21.1%– 90.1% of the patients. Combined therapy with a longacting bronchodilator and inhaled corticosteroids was used in 45.9% of patients. Up to 27.8% of those with an indication for treatment with inhaled corticosteroids did not receive these drugs (11). In Iran, there are no local standard guidelines for managing COPD, and to the best of our knowledge no studies to date have evaluated physicians’ adherence to the international GOLD guidelines. We designed this study to determine the level of adherence to GOLD guidelines for the inpatient treatment of COPD exacerbations at our hospital.
Materials and methods Research design A cross-sectional descriptive design was used in this research.
Study setting The study was conducted from January 2011 to April 2012 in the medical emergency department of Shahid
2
Masoompour et al.
Faghihi Hospital in the city of Shiraz, the capital of Fars province, Iran. This public teaching hospital has 360 active beds and is a referral center for southern Iran.
Participants and data collection tool During January 2011 to April 2012, we included all consecutive patients admitted to our hospital because of an exacerbation of COPD. All patients had physician-diagnosed COPD. Patients were excluded if they were discharged or died within 24 h of admission. After permission was obtained to visit the patients and access their charts, a trained researcher (A. M.) interviewed each patient and extracted data from his or her medical record with a specially designed datagathering form. The form contained two parts: the first part included general characteristics of patients such as age, gender, number of days since admission and final outcome, and the second part contained treatment data. Adherence was measured by reviewing the patients’ data for 11 major components of treatment (Table 1) and comparing them with the GOLD guidelines.
Statistical analysis Continuous variables are presented as mean values (±standard deviation, SD). Categorical variables are presented as absolute numbers and percentages. SPSS 11.5 software (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses. The differences were considered statistically significant at a P value
