COPD routine management in France: Are guidelines used in clinical practice?

Introduction. - COPD management guidelines have been proposed to improve the major outcomes for COPD patients. In clinical practice, COPD treatment is only partially consistent with current guidelines and recommendations. Objective. - Global initiative for chronic obstructive lung disease (GOLD) guidelines are based on a COPD severity scale and are subject to change as the evidence based evolves. The main purpose of our study was to access whether the treatments prescribed to patients with COPD were consistent with these guidelines. Methods. - Treatments prescribed by French physicians to 542 patients with COPD in stable conditions were recorded according to the severity of obstruction, using GOLD classification. We compared our prescription data base with the GOLD guidelines. Results. - Forty percent of the initial physicians were chest specialists. Patients: 78.3% men, (64.8 +/- 10.8 years) and 25% were still smokers at inclusion. We found an important discrepancy between recommended treatment and COPD severity. Bronchodilators were commonly prescribed, but 11% in severe COPD (stages III and IV) did not receive them. Inhaled steroids (ICS) were used respectively in 55.2%, 59.4% of patients in stages 1, 11 (FEV1 > 50%) (for whom they are not recommended) and 77.4 and 85.3% in stages III and IV. Only 30% of patients used ICS + beta 2 agonists in the same device. Influenza vaccination had been performed in only half of patients whatever the severity of COPD. Pulmonary rehabilitation had been used by 10% of patients, (stage 11: 6.4%, stage 111: 9.6%, stage IV: 20.6%). Conclusions. - We confirmed that there are discrepancies between COPD guidelines and routine treatments. Some treatments such as ICS were overused in mild phenotypes, whereas in a high proportion of cases influenza immunisation and rehabilitation were omitted. (C) 2009 Elsevier Masson SAS. All rights reserved.