Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort

Veronika Mangold; Maria Boesing; Camille Berset; Pierre-Olivier Bridevaux; Thomas Geiser; Ladina Joos Zellweger; Malcolm Kohler; Giorgia Lüthi-Corridori; Sabrina Maier; David Miedinger; Robert Thurnheer; Christophe von Garnier; Jörg Daniel Leuppi

doi:10.3390/jcm12206636

Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort

J Clin Med. 2023 Oct 20;12(20):6636. doi: 10.3390/jcm12206636.

Authors

Veronika Mangold^{1

2}, Maria Boesing^{1

2}, Camille Berset^{1

2}, Pierre-Olivier Bridevaux³, Thomas Geiser⁴, Ladina Joos Zellweger⁵, Malcolm Kohler⁶, Giorgia Lüthi-Corridori^{1

2}, Sabrina Maier¹, David Miedinger^{1

2}, Robert Thurnheer⁷, Christophe von Garnier⁸, Jörg Daniel Leuppi^{1

2}

Affiliations

¹ University Center of Internal Medicine, Cantonal Hospital Baselland, 4410 Liestal, Switzerland.
² Faculty of Medicine, University of Basel, 4056 Basel, Switzerland.
³ Clinic of Pneumology, Hospital of Valais, University of Geneva, 1205 Geneva, Switzerland.
⁴ Department of Pulmonary Medicine and Allergology, University Hospital, University of Bern, 3010 Bern, Switzerland.
⁵ Department of Pneumology, Claraspital, 4058 Basel, Switzerland.
⁶ Department of Pneumology, University Hospital Zürich, 8091 Zürich, Switzerland.
⁷ Clinic of Medicine, Department of Pneumology, Cantonal Hospital Münsterlingen, 8596 Münsterlingen, Switzerland.
⁸ Division of Pulmonology, Department of Medicine, University Hospital Lausanne, CHUV, University of Lausanne, 1011 Lausanne, Switzerland.

Abstract

(1) Introduction: Chronic obstructive pulmonary disease (COPD) and its associated morbidity and mortality are a global burden on both affected patients and healthcare systems. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues guidelines with the aim of improving COPD management. Previous studies reported significant variability in adherence to these recommendations. The objective of this study was to evaluate Swiss primary practitioners' adherence to the GOLD guidelines for the pharmacological treatment of stable COPD. (2) Methods: We studied patients who were included in the Swiss COPD cohort study, an ongoing prospective study in a primary care setting, between 2015 and 2022. The key inclusion criteria are age ≥ 40 years, FEV1/FVC ratio < 70%, and a smoking history of at least 20 pack-years. Adherence to the GOLD guidelines was assessed per visit and over time. (3) Results: The data of 225 COPD patients (mean age 67 ± 9 years, 64% male) and their respective 1163 visits were analyzed. In 65% of visits (726/1121), treatment was prescribed according to the GOLD guidelines. Non-adherence was most common in GOLD groups A and B (64% and 33%) and mainly consisted of over-treatment (two long-acting bronchodilators in group A (98/195, 50%) and ICS in groups A (21/195, 11%) and B (198/808, 25%)). In group D, the prescriptions conformed with the guidelines in 99% of cases (109/108). Guideline adherence was associated with high symptom load (COPD Assessment Test) (OR 1.04, p = 0.002), high number of exacerbations (OR = 2.07, p < 0.001), asthma overlap (OR 3.36, p = 0.049), and diabetes mellitus (OR 2.82, p = 0.045). (4) Conclusion: These results confirm a conflict between the GOLD recommendations and primary practice, mainly concerning over-treatment in GOLD groups A and B. Patients with high symptom load, high exacerbation risk, asthma overlap, and diabetes mellitus are more likely to be treated in conformity with the guidelines. Further research is needed to uncover the reasons for the discrepancies and to design strategies for improvement.

Keywords: COPD; GOLD guidelines; adherence; bronchodilators; inhaled corticosteroids; primary care.

Abstract

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