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Background: Chronic obstructive pulmonary disease (COPD) is a preventable, progressive disease and the third leading cause of death worldwide. The epidemiological data of COPD from Gulf countries are very limited, as it remains underdiagnosed and underestimated. Risk factors for COPD include tobacco cigarette smoking, water pipe smoking (Shisha), exposure to air pollutants, occupational dusts, fumes, and chemicals. Inadequate treatment of COPD leads to worsening of disease. The 2024 GOLD guidelines recommend use of inhaled bronchodilators, corticosteroids, and adjunct therapies for treatment and management of COPD patients based on an individual assessment of the severity of symptoms and risk of exacerbations. This article reviews COPD pharmacotherapy in the Gulf countries and explores the role of nebulization in the management of COPD in this region. Methods: To review the COPD pharmacotherapy in the Gulf Countries, literature search was conducted using PubMed, Medline, Cochrane Systematic Reviews, and Google Scholar databases (before December 2022), using search terms such as COPD, nebulization, inhalers/inhalation, aerosols, and Gulf countries. Relevant articles from the reference list of identified studies were reviewed. Consensus statements, expert opinion, and other published review articles were included. Results: In the Gulf countries, pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), soft mist inhalers, and nebulizers are used for drug delivery to COPD patients. pMDIs and DPIs are most prone to errors in technique and other common device handling errors. Nebulization is another mode of inhalation drug delivery, which is beneficial in certain patient populations such as the elderly and patients with cognitive impairment, motor or neuromuscular disorders, and other comorbidities. Conclusion: There is no major difference between Gulf countries and rest of the world in the approach to management of COPD. Nebulizers should be considered for patients who have difficulties in accessing or using MDIs and DPIs, irrespective of geographical location. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of global morbidity and mortality, with acute exacerbations significantly worsening patient outcomes. These exacerbations often lead to hospitalizations and increased healthcare costs. Proper management, guided by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, is essential to improving care. However, real-world adherence to these recommendations can vary. Objective: To assess how acute COPD exacerbations were handled at a tertiary care hospital of Peshawar. Methodology: In the emergency department of Hayatabad Medical Complex Peshawar, between November 2021 and December 2023, we retrospectively examined clinical data of patients presenting with acute exacerbations of COPD. The management was assessed in light of the GOLD 2019 report's and earlier audits' recommendations. Results: Total 170 patients (mean age 73 years, range 41-95 years, 54% male) were included. GOLD risk group (A-D) was only documented in 39% of the cases. At the time of presentation, 74% of the patients had their respiratory rate evaluated, and 69% had their blood gas analysis done. In all, 95% of the patients had chest imaging performed. Short-acting bronchodilators were used as initial symptomatic management in 56% of cases. Among them, 92% had systemic steroid therapy implemented. Conclusion: The GOLD guidelines were not fully followed, particularly in relation to non-invasive breathing, early symptomatic treatment, and severity assessment. These findings highlight the significance of periodic practice revisions on a regular basis, which may raise practitioners' knowledge and enhance the standard of COPD care in the long run. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnoea. Frailty is a complex clinical syndrome associated with an increased vulnerability to adverse health outcomes. The aim of this review was to explore the current evidence of the influence of frailty on symptoms in patients with a confirmed diagnosis of COPD according to GOLD guidelines. Fourteen studies report a positive association between frailty and symptoms, including dyspnoea, assessed with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale. Data were analysed in a pooled a random-effects meta-analysis of mean differences (MDs). There was an association between COPD patients living with frailty and increased CAT score versus COPD patients without frailty [pooled SMD, 1.79 (95% CI 0.72–2.87); I2 = 99%]. A lower association was found between frailty and dyspnoea measured by the mMRC scale versus COPD patients without frailty [pooled SMD, 1.91 (95% CI 1.15–2.66); I2 = 98%]. The prevalence of frailty ranged from 8.8% to 82% and that of pre-frailty from 30.4% to 73.7% in people living with COPD. The available evidence supports the role of frailty in worsening symptom burden in COPD patients living with frailty. The review shows that frailty is common in patients with COPD. Future research is needed to have further details related to the data from CAT to improve our knowledge of the frailty impact in this population. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable illness that carries a large global economic and social burden. The global initiative for chronic obstructive lung disease (GOLD) guidelines has been utilized as a global strategy for the continued COPD diagnosis, assessment, and treatment. We aimed to determine if the adherence to the 2021 GOLD guideline directed management influenced outcomes. Materials and Methods: Retrospective medical records review of adult patients with COPD, who received care in our office during the entire year of 2021. Patients managed as per the 2021 GOLD guidelines were compared with those who received usual care. Results: Among 242 patients, 171 (70.7%) were GOLD management adherent (GA) and 71 (29.3%) were GOLD non-adherent (GNA). Certain comorbidities were associated with higher frequencies in the GA group, such as allergic rhinitis (63.2 vs. 18.3%; P < 0.001), coronary artery disease (55.9 vs. 38.0%; P = 0.011), GERD (63.2 vs. 32.4%; P < 0.001), anemia (38.6 vs. 19.7%; P = 0.004), malignancy (34.5 vs. 19.7%; P = 0.023), and immunodeficiency (12.3 vs. 1.4%; P = 0.007). There was no significant difference in the mortality between the GA and GNA groups (5.3 vs. 9.9%; P = 0.254). Although the frequency of number of exacerbations was greater in the GA group, the difference in the mean number of exacerbations was not statistically significant (0.39 ± 1.08 vs. 0.39 ± 1.14; P = 0.984). Conclusion: We found no significant difference in the patient outcomes, such as number of exacerbations of COPD and mortality, when comparing the 2021 GOLD guideline adherent versus GOLD guideline non-adherent management of COPD. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic obstructive pulmonary disease (COPD) is currently one of the leading causes of death worldwide, with 90% of these deaths reported in low- and middle-income countries. In Lebanon, the prevalence of COPD is 9.7%. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the use of antibiotics and corticosteroids in inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The studies examining the level of conformity with the GOLD recommendations are rare, which increases the need for the current study. Methods A 3-month cross-sectional study was done. Patients included were those diagnosed with acute exacerbations of COPD and admitted to one of the selected hospitals in Beirut, of various nationalities and sexes, aged 18 to 89. Data were selected from patient files admitted between January 2020 and June 2022 using a data collection sheet. The SPSS version 24 statistics software was used to conduct statistical analysis. Results A total of 260 patients were recruited, with 86.7% receiving systemic corticosteroids, 24.3% respecting dose, and 81.8% respecting the appropriate duration of corticosteroid intake. 80% exhibited pulmonary indications for receiving antibiotics, and 56.53% had the necessary cardinal symptoms. Around 74.5% of patients use antibiotics for the recommended time of 5 to 7 days. Age (p value = 0.006), gender (p value = 0.049), alcohol consumption (p value = 0.018), and use of psychiatric medications (p value = 0.049) are correlated with the conformity index of corticosteroid administration. A correlation was observed between the duration of use of antibiotics with cardinal symptoms (p value = 0.003), CRP-value (p value = 0.007), and type of hospital (p value = 0.00). Conclusion This investigation revealed a need for correction in a deviation from the guidelines, shed light on existing clinical procedures, and emphasized the growing concern about the uncontrollable rate of antibiotic use and inadequate corticosteroid dosing.

(1) Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are not only associated with increased patient morbidity and mortality, but with extensive healthcare costs. Thus, adequate clinical management is crucial. The aim of this project was to evaluate the management of acute COPD exacerbations in a public teaching hospital in Switzerland. (2) Methods: We retrospectively analyzed clinical routine data of patients presenting with an acute exacerbation of COPD at the emergency department of a Swiss hospital between January 2019 and February 2020. Management was evaluated against recommendations from the GOLD 2019 report and previous audits. (3) Results: The data of 184 patients (mean age 73.5 years, range 41–95 years, 53% male) with 226 visits were included. While the documentation of GOLD stage (I-IV) and smoking status was consistent (81.0% and 91.6%), GOLD risk category (A-D) was only documented in 36% of the cases. Patients' respiratory rate upon presentation was measured in 73%, and blood gas analysis was performed in 70%. A total of 94% of the patients received a chest imaging; spirometry was performed in 10%. Initial symptomatic therapy with short acting bronchodilators was applied in 56%. Systemic steroid treatment was installed in 86%. Antibiotics were given in 56%, but in one fourth the indication was not clear. Non-invasive ventilation was applied in 25% of the indicated cases. Smoking cessation was recommended to 26% of the current smokers and referral to pulmonary rehabilitation was given in 16%. (4) Conclusion: GOLD recommendations were not comprehensively implemented, especially with regard to the assessment of severity, initial symptomatic therapy, and non-invasive ventilation. These results show the importance of the frequent revision of routine practice and may help to create awareness among practitioners and ultimately improve the quality of COPD management. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is currently one of the leading causes of death worldwide, with 90% of these deaths reported in low- and middle-income countries. In Lebanon, the prevalence of COPD is 9.7%. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the use of antibiotics and corticosteroids in inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The studies examining the level of conformity with the GOLD recommendations are rare, which increases the need for the current study. Methods: A 3-month cross-sectional study was done. Patients included were those diagnosed with acute exacerbations of COPD and admitted to one of the selected hospitals in Beirut, of various nationalities and sexes, aged 18 to 89. Data were selected from patient files admitted between January 2020 and June 2022 using a data collection sheet. The SPSS version 24 statistics software was used to conduct statistical analysis. Results: A total of 260 patients were recruited, with 86.7% receiving systemic corticosteroids, 24.3% respecting dose, and 81.8% respecting the appropriate duration of corticosteroid intake. 80% exhibited pulmonary indications for receiving antibiotics, and 56.53% had the necessary cardinal symptoms. Around 74.5% of patients use antibiotics for the recommended time of 5 to 7 days. Age (p value = 0.006), gender (p value = 0.049), alcohol consumption (p value = 0.018), and use of psychiatric medications (p value = 0.049) are correlated with the conformity index of corticosteroid administration. A correlation was observed between the duration of use of antibiotics with cardinal symptoms (p value = 0.003), CRP-value (p value = 0.007), and type of hospital (p value = 0.00). Conclusion: This investigation revealed a need for correction in a deviation from the guidelines, shed light on existing clinical procedures, and emphasized the growing concern about the uncontrollable rate of antibiotic use and inadequate corticosteroid dosing. [ABSTRACT FROM AUTHOR]

Andrea Vuki&cacute; Dugac,1,2 Mirna Vergles,3 Sanda Škrinjari&cacute; Cincar,4 Ljiljana Bulat Kardum,5 Marina Lampalo,1 Sanja Popovi&cacute;-Grle,1,2 Jelena Ostoji&cacute;,6 Tatjana Toki&cacute; Vuksan-&Cacute;usa,7 &Zcaron;arko Vrbica,8,9 Emilija Lozo Vukovac,10 Neven Tudori&cacute;11 1Clinic for Respiratory Diseases, University Hospital Centre Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Pulmonology, Clinical Hospital Dubrava, Zagreb, Croatia; 4Faculty of Medicine, University of Osijek, Osijek, Croatia; 5Department of Pulmonology, Clinical Hospital Centre Rijeka, Rijeka, Croatia; 6Pulmonary Outpatient Clinic, Special Hospital for Pulmonary Diseases, Zagreb, Croatia; 7Department of Internal Medicine, Karlovac General Hospital, Karlovac, Croatia; 8Department of Internal Medicine, Dubrovnik General Hospital, Dubrovnik, Croatia; 9University Study Programme Nursing, University of Dubrovnik, Dubrovnik, Croatia; 10Department of Pulmonology, University Hospital Split, Split, Croatia; 11Pulmonary Outpatient Clinic, St. Catherine Specialty Hospital, Zagreb, CroatiaCorrespondence: Neven Tudori&cacute;, St. Catherine Specialty Hospital, Branimirova Ul. 71E, Zagreb, 10000, Croatia, Tel +385915832449, Email neven.tudoric@gmail.comIntroduction: Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) lead to poor outcomes and increased burden for patients and healthcare systems. The Global Initiative for COPD (GOLD) includes specific recommendations for AECOPD interventions, discharge criteria, and follow-up. Aligning the AECOPD discharge letters (DL) with GOLD guidelines could facilitate dissemination of recommendations among general practitioners (GPs).Purpose: This study was conducted to assess the compliance of DL with the GOLD recommendations in Croatia.Methods: Pre-pandemic DL of patients presenting for AECOPD to emergency room (ER) were analyzed and stratified by clinical decision to hospitalize (HDL) or discharge patients for outpatient treatment (ERDL). Experienced pulmonologists checked the information from DL against guidelines by using online study-specific questionnaires.Results: In total, 225 HDL and 368 ERDL were analyzed. In most cases, the GOLD ABCD categories (85% HDL, 92% ERDL) or the spirometry-based degree of severity (90% HDL, 91% ERDL) were not included. The number of AEs in the previous year was recorded, but the specific frequent exacerbator phenotype not explicitly stated. The AE phenotype was included in two thirds of HDL and one third of ERDL. The blood eosinophil count was frequently available, but not considered decision-relevant information. Adjustments of previous maintenance therapy, mostly escalation, were recommended in 58.4% HDL and 27.9% ERDL, respectively. Education on proper use of inhalers was recommended only in 15.6% of HDL. Smoking cessation measures were advised in 23.1% HDL and 7.9% ERDL; pulmonary rehabilitation in 35.6% HDL and 0.8% ERDL. Early follow-up was frequently advised (> 50%), but rarely appointed.Conclusion: Significant deficiencies in compliance with the GOLD guidelines were identified, translating into a missed opportunity for GPs to become acquainted with GOLD recommendations. These findings emphasize the necessity to increase compliance with guidelines first at specialist level and consequent standardization of DL.Keywords: COPD, GOLD guidelines, acute exacerbation, discharge record

COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.

(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. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a progressive pulmonary disorder underpinned by poorly reversible airflow resulting from chronic bronchitis or emphysema. The prevalence and mortality of COPD continue to increase. Pharmacotherapy for patients with COPD has included antibiotics, bronchodilators, and anti-inflammatory corticosteroids (but with little success). Oral diseases have long been established as clinical risk factors for developing respiratory diseases. The establishment of a very similar microbiome in the mouth and the lung confirms the oral-lung connection. The aspiration of pathogenic microbes from the oral cavity has been implicated in several respiratory diseases, including pneumonia and chronic obstructive pulmonary disease (COPD). This review focuses on current and future pharmacotherapeutic approaches for COPD exacerbation including antimicrobials, mucoregulators, the use of bronchodilators and anti-inflammatory drugs, modifying epigenetic marks, and modulating dysbiosis of the microbiome. [ABSTRACT FROM AUTHOR]

Objectives : Adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treatment is variable in the inpatient setting. This study evaluates appropriateness of therapy in patients admitted to an academic medical center for AECOPD. Methods : This was a single-center, retrospective, observational study. The primary endpoint was proportion of patients who received appropriate AECOPD treatment within 24 h. Secondary endpoints included mean length of stay (LOS) and time to administration (TTA) of pharmacotherapy, 30-day readmission rates, and proportions of various ancillary care received. Data were analyzed using descriptive and inferential statistics. Results : Of 533 screened admissions, 163 were included. Of those included, 55% (n = 90) received guideline-based therapy within 24 h of presentation. This group had significantly shorter mean LOS (3.48 ± 2.61 vs 4.53 ± 3.40 days, p =.026), fewer COPD-related readmissions (7 vs 14, p =.036), and numerically fewer all-cause readmissions (14 vs 19, p =.11). Mean LOS and TTA were 3.95 ± 3.02 days and 8.47 ± 12.77 h, respectively. Discussion: Timely and guideline-based delivery of medications was associated with shorter length of stay and fewer COPD-related readmissions. Establishing a standardized care plan through order set implementation may be one strategy to improve care and outcomes in AECOPD patients. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a progressive pulmonary disorder underpinned by poorly reversible airflow resulting from chronic bronchitis or emphysema. The prevalence and mortality of COPD continue to increase. Pharmacotherapy for patients with COPD has included antibiotics, bronchodilators, and anti-inflammatory corticosteroids (but with little success). Oral diseases have long been established as clinical risk factors for developing respiratory diseases. The establishment of a very similar microbiome in the mouth and the lung confirms the oral-lung connection. The aspiration of pathogenic microbes from the oral cavity has been implicated in several respiratory diseases, including pneumonia and chronic obstructive pulmonary disease (COPD). This review focuses on current and future pharmacotherapeutic approaches for COPD exacerbation including antimicrobials, mucoregulators, the use of bronchodilators and anti-inflammatory drugs, modifying epigenetic marks, and modulating dysbiosis of the microbiome.

Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend triple therapy (TT) for chronic obstructive pulmonary disease (COPD) patients based on severity. TT utilization by severity is infrequently studied in real-world settings and may deviate significantly from current clinical recommendations. This study describes prescribing pathways to TT among patients with COPD in the United States. Methods: This study analyzed Geisinger Health System electronic medical records from 1 January 2004 to 30 November 2016. Two retrospective cohorts of COPD patients were included: (1) incident COPD, and (2) incident TT users. COPD treatment patterns, including time to TT, were summarized. Time to TT was estimated using Kaplan–Meier methods. Predictors of the relative hazard for TT among incident COPD patients were estimated using Cox proportional hazards regressions. Results: Incident COPD and TT cohorts included 57,141 and 8173 patients, respectively. TT was used by 9.6% of incident COPD patients. In the year before TT, 34.3% of incident TT patients received treatment combinations recommended before TT according to GOLD recommendations, which mainly included: long-acting muscarinic antagonists (LAMAs), long-acting beta agonists (LABAs) + LAMAs, and inhaled corticosteroids + LABAs. Among incident TT patients, median time from COPD diagnosis to TT exceeded 2 years. The hazard for TT over time was associated with lower forced expiratory volume in 1 s values, more frequent exacerbations, current/previous smoking, and comorbid lung conditions such as pulmonary vascular disease, acute respiratory failure, and lung cancer. About 15–20% of the incident TT patients stepped down to a one- or two-drug regimen. Median time to TT discontinuation or step-down were 2 and 9 months, respectively. Conclusion: The study has revealed discrepancies in the treatment of COPD patients between GOLD guidelines and actual clinical practices in the United States. Pathways to TT differed from recommended therapy regimes. Further studies are needed to understand barriers to the use of guideline-recommended TTs by healthcare providers. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Meng-Jer Hsieh,1,2 Shu-Yi Huang,1 Tsung-Ming Yang,1 Chi-Wei Tao,3 Shih-Lung Cheng,4 Chao-Hsien Lee,5 Ping-Hung Kuo,6 Yao-Kuang Wu,7,8 Ning-Hung Chen,9 Wu-Huei Hsu,10 Jeng-Yuan Hsu,11 Ming-Shian Lin,12 Chin-Chou Wang,13 Yu-Feng Wei,14 Ying-Huang Tsai1,2 1Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang-Gung Medical foundation, Chiayi, Taiwan; 2Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan; 3Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan; 4Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei; 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; 6Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 7Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 8School of Medicine, Tzu Chi University, Hualien, Taiwan; 9Department of pulmonary and critical care medicine, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 11Division of Chest Medicine, Taichung Veterans General Hospital, Taiwan; 12Dpartment of Internal Medicine, Ditmanson Medical Foundation, Chia-Yi Cristian Hospital, Chia-Yi, Taiwan; 13Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang-Gung Medical Foundation, Kaohsiung, Taiwan; 14Department of Internal Medicine E-Da Hospital, I-Shou University, Kaohsiung, Taiwan Background: This 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 methods: Data 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.Results: A 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.Conclusion: The 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. Keywords: chronic obstructive pulmonary disease, GOLD guidelines, inhaled corticosteroids, long-acting bronchodilators

Eirini Stafyla, Ourania S Kotsiou, Konstantina Deskata, Konstantinos I Gourgoulianis Department of Respiratory Medicine, School of Medicine, University of Thessaly, Biopolis, Larissa, Thessaly, Greece Background: The diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program. Methods: A study was conducted in 10 primary health care centers of Central Greece during a 7-month period. Eligible participants were aged ≥40 years and were either current smokers or exsmokers. Results: A total of 186 subjects were included (68% males, mean age 62.3±12.6 years, mean life-time tobacco exposure 50 pack-years). COPD prevalence was 17.8%, identified to be higher in elderly males. Forty-two percent of the COPD group were newly diagnosed patients, who were of younger age, current smokers, presented with less dyspnea and better health status, and mainly appeared with mild-to-moderate disease. Interestingly, 61.4% of non-COPD and 85.7% of newly diagnosed COPD individuals had been using inhaled medication under primary care provider’s prescription without ever undergoing spirometry or further evaluation by a pulmonologist; thus, the phenomena of COPD overdiagnosis and missed diagnosis came into the spotlight. Moreover, only 26.3% of known COPD patients were properly medicated according to GOLD guidelines, while half of them were inappropriately treated with triple inhaled therapy. Conclusion: We reported a significant prevalence of COPD in smoking population attending this spirometry program. A remarkable proportion of COPD patients were undiagnosed and made case finding worthwhile. Underutilization of spirometry in the diagnosis and management of COPD as well as general practitioners’ nonadherence to the GOLD treatment guidelines was confirmed by our data. These findings highlight the need for a major overhaul and culture change in primary care settings of Central Greece. Keywords: COPD management, GOLD guidelines, treatment, spirometry program, primary care

Introduction: The international standard for the recognition and treatment of chronic obstructive pulmonary disease (COPD) is guided by a regularly updated set of criteria developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Aim: To investigate the impact of updated COPD management guidelines from 2007 to 2017 (GOLD 2007, GOLD 2011 and GOLD 2017) on the assignment of patients into individual therapeutic groups, examining both individual and population dimensions. Material and methods: Each of 500 randomly chosen primary care physicians in Poland provided information on 10 individual COPD patients (disease history, clinical status, treatment and pharmacotherapy). This data was used to simulate the consequences of the implementation of the GOLD 2007, 2011 and 2017 guidelines. Results: A group of 298 physicians of 500 approached provided information on 2597 patients (64.2% males) aged 29-96 (61.6 ±11.1 years). Based on GOLD 2007 guidelines, most patients (56.7%) presented a severe stage of COPD. GOLD 2011 updates would significantly increase the proportion of patients with the most severe stage of disease, and this group would be predominantly classified as moderate or severe in GOLD 2007. The implementation of GOLD 2017 guidelines would result in a significant migration of patients towards the lightest (category A) form of the disease. Conclusions: Updates to the GOLD 2007 COPD guidelines for GOLD 2011 and 2017 would have a significant impact on the classification of patients for particular therapeutic groups. As a result of the migration of patients to particular therapeutic groups, the pharmacological treatment would also change. [ABSTRACT FROM AUTHOR]

Abstract Background and objectives Chronic obstructive pulmonary disease (COPD) is defined as ‘a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients’. Its pulmonary component is characterized by airflow limitation that is not fully reversible. There is a wide variation in physicians’ management of the condition, and this may be ascribed to nonadherence to the guidelines. Adherence to COPD guidelines in clinical practice in most countries is not satisfactory. Aim The aim of this work is to assess the prescription pattern and clinical practice attitudes toward Egyptian COPD patients managed by chest physicians and internal medicine physicians in Abbassia Chest Hospital and Ain Shams University Hospitals during the period from February 2013 to January 2014. Patients and methods In this study, one questionnaire was specifically directed to physicians. Sixty doctors were at Abbassia Chest Hospital, 63 at Ain Shams University Hospitals, and six doctors at Ministry Hospitals. Doctors were chest residents (29.5%), chest physicians with masters degree (33.3%), chest physicians with MD (13.2%), or internal medicine doctors (34%). Results Only 53 physicians performed spirometry. Most of the physicians prescribed antibiotics and systemic steroids to their patients in exacerbations. Macrolides, cephalosporins, and quinolones were the most commonly prescribed antibiotics by physicians in COPD exacerbations. Only 46 physicians used noninvasive ventilation in hypercapnic respiratory failure. Only 33 physicians were following GOLD 2013 guidelines. Conclusion Doctors’ awareness of guidelines is suboptimal; major deviations from the GOLD guidelines were in the form of underuse of spirometry, smoke cessation programs, and of noninvasive ventilation in exacerbations and lack of use of pulmonary rehabilitation treatment.

Abstract Background COPD is one of the leading causes of morbidity and mortality. Pharmacotherapy improves quality of life and reduces exacerbations although low adherence with prescribed treatments may represent a barrier to optimal disease management. The first objective of this paper is to report the distribution of COPD patients according to GOLD categories, in a sample of patients from a cohort study in an area of the Latium region in Italy. The second objective is to evaluate the agreement between the distributions of severity obtained from the HCPs and the experts included in the study board (Board). Methods COPD patients were given a card to collect demographic and clinical data at baseline. Information in those cards was independently evaluated by HCPs and Board to include each patient into one of the four GOLD categories. Results In a sample of 187 stable COPD patients, 59% male, mean age 70 year, the distribution of GOLD categories according to the Board was: 6% A, 34% B, 2% C, and 58% D. A discrepancy in GOLD classification was observed between the study board and field-based HCPs, regarding more than 50% of the patients, with a clear trend to underestimate the frequency of patients in D level (21%) and to overestimate the frequency in C level (21%). Conclusions These results describe for the first time the distribution of COPD patients in an Italian cohort according to the GOLD categories, with the highest frequencies in levels B and D. The misclassification from HCPs may impact the therapeutic approach and the clinical outcomes.

Background: Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD., Research Question: To examine rates of guideline alignment and medication concordance and to identify patient-level factors that place patients at risk for these types of poor disease management outcomes., Study Design and Methods: This study was a secondary data analysis of the Medication Adherence Research in COPD study (2017-2023). Participants were categorized into 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Medication regimens were classified as aligned or nonaligned with 2017 GOLD guidelines. Nonaligned regimens were stratified further into overuse and underuse categories. Medication concordance between provider-reported and participant-reported regimens was determined. Factors associated with guideline alignment and medication concordance were evaluated using logistic regression., Results: Of 191 participants, 51% of provider-reported regimens were guideline aligned, with 86% of nonaligned regimens reflecting overuse with an inhaled corticosteroid (ICS). Thirty-eight percent of participants reported different regimens than their providers, of which > 80% reflected participants not reporting medications their providers reported prescribing. Participants did not report long-acting muscarinic antagonists and long-acting beta-agonists at similar rates as ICSs. Greater symptom burden and absence of a pulmonologist on the care team were associated with both guideline misalignment and medication discordance. Cognitive impairment and Black race additionally were associated with medication discordance., Interpretation: Guideline misalignment and medication discordance were common and were driven by overuse of ICSs and unreported medications, respectively. The patient-level factors associated with medication discordance highlight the importance of improving patient-provider communication to improve clinical management in COPD.

Background: Irrational prescribing results produce a negative impact on health and economy of both individuals and society, leading to wastage of resources and widespread health hazards. Method: Outpatients with mild, moderate, and severe COPD were included. Several parameters were noted: patient's age and gender, outpatient (OPD) ID number, date of admission, occupation, h/o smoking, alcohol consumption, etc, disease condition details (duration, gradation as mild, moderate and severe, and co-existing diseases), prescribed medication details (dose, frequency, route of administration, and duration). Drug selection was assessed as per GOLD guidelines, the severity of disease was categorized according to the same guidelines, and medication efficacy was evaluated by treatment outcome according to the modified MRC dyspnoea scale. Results: Inhalation route (36.95%) was the most preferred route of drug administration in this study, followed by the parenteral route (34.34%), and enteral route (28.71%). Adherence to GOLD 2015: All patients (n=400) were categorized to Gold stages I to IV based on the severity of COPD. Amongst these patients, 11 were in stage I, 146 in stage II, 184 in stage III, and 59 in stage IV. The majority of subjects received fixed-dose combination therapy: levocetirizine + montelukast (77%) and least bromhexine + guaiphenesin + terbutaline + menthol (18%). Dyspnoea status was graded from 0 to 4 according to the modified MRC dyspnea scale. Out of the 400 patients, 18 had grade 0, 44 grade 1, 156 grade 2, 133 grade 3, and 49 grade 4. Conclusion: Overall, data from this analysis suggest that adherence to GOLD guidelines does not have a perceivable impact on symptom prevalence, exacerbation rate or lung function. Male sex, asthma and severe co-morbidities as a cerebrovascular insult could be associated with a risk for frequent exacerbations. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the adherence to clinical guidelines for appropriate use of antibiotics in patients with COPD exacerbations, and to explore the association between this prescription and clinical outcomes. Methods: a retrospective cohort study of patients admitted with COPD diagnosis between January 1, 2010 and December 31, 2012. The following variables were recorded: socio-demographic characteristics, spirometric classification, oxygen use at home, number of exacerbations in the previous year, recent antibiotic use, previous need for mechanical ventilation, previous vaccination, comorbidities, clinical presentation, antibiotic use indications and vital status. Results: 419 patients were included, 59 % (n = 247) were women, median age was 76 years, 62 % had clinical diagnosis, 75 % had an established outpatient management and 11 % had been previously treated for exacerbation of COPD. Out of 170 patients with any indication for using antibiotics the latter were prescribed in 140 (82 %), while 118 (47 %) of 249 patients with no criterion for their use received them. Mortality rate was higher in the group with indications for antibiotics. Conclusions: an acceptable level of adherence to guidelines was observed in the use of antibiotics when indicated. However, the percentage of patients in whom antibiotics were unnecessarily prescribed seems to be larger than expected and demands further investigation.

Objective: To determine the prevalence of vitamin D deficiency in patients with COPD and bronchial asthma, and the relation of vitamin D serum levels to pulmonary spirometric measures as well as other important clinical parameters that could affect quality of life in these patients. Subjects and methods: The study included 80 subjects: 30 patients with COPD and 30 patients with bronchial asthma and 20 healthy volunteers. Patients and control groups were subjected to vitamin D assay by ELISA as well as spirometric assessment. Assessment of patients with COPD was done according to GOLD guidelines 2013: using (mMRCs), CAT score, spirometric assessment of FEV1, and exacerbation assessment. They were also subjected to Combined COPD assessment and BODE index calculation. For all patients with bronchial asthma, GINA classification 2014 of bronchial asthma severity and asthma control assessment were done. Results: Statistically significant lower values of vitamin D were found in patients with COPD (11.94 ± 7.66 ng/ml) compared to patients with bronchial asthma (22.03 ± 8.19 ng/ml) with p

Background: Chronic obstructive pulmonary disease (COPD) is a progressive illness that is mostly managed in the general practice setting. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are the international gold standard, and it is important to understand how these are being applied in general practice.Aims: This review aimed to assess the current level of adherence to international best practice guidelines among general practitioners in relation to COPD.Methods: PubMed and EMBASE searches (from 2012 to 2016) were performed and used the search terms guidelines, COPD, general practitioners, and primary care. Papers were excluded if they were not primary sources, were published before 2012, or did not pertain to a general practice setting.Results: After applying set inclusion and exclusion criteria, 11 studies were retrieved. These papers were grouped under three categories: diagnosis, pharmacological, and non-pharmacological management, based on the GOLD guidelines.Conclusions: Current studies show significant variability in adherence to the GOLD guidelines. Barriers identified include lack of clarity, unfamiliarity with recommendations, and lack of familiarity with the guidelines. If general practice is expected to manage COPD and other chronic diseases, health service investment is needed to provide appropriate focused guidelines, to support their dissemination and resources to implement them in practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Aim of this study was the evaluation of the adherence level to GOLD guidelines for the COPD patients’ treatment in the Italian GPs setting, observing the time trend on ICS therapies’ pharmacoutilization, specifically in mild and moderate COPD patients, which is considered inappropriate by GOLD guidelines. Moreover, a pharmacoeconomic analysis has been implemented in order to evaluate the economical burden of the improper management of COPD. METHODS: The retrospective GPs database study has analyzed patients with at least one diagnosis of COPD during the periods January 2005 – December 2008 (Cohort 1) and January 2009 – December 2011 (Cohort 2), who had a reported value of VEMS, at least one prescription of a drug from ATC R03 class within two months from the date of spirometric exam and aged 40 or more. Disease severity has been defined according to 2008 GOLD guidelines. Comparison between the cohorts has been implemented to verify possible variations in guideline adherence. Furthermore, an economical analysis has been developed in order to highlight saves obtained by following GOLD guidelines and the total inappropriate therapies’ costs. RESULTS: The first cohort involved 2,103 COPD patients, while the second cohort included 1,647 subjects. Reduction of ICS therapies has been shown between the two cohorts, with a decrease of 8.4% for mild patient and 1.6% for moderate patients; considering all the disease severities, the reduction was about 4%. Pharmacoeconomic analysis on mild and moderate patients has pointed out that about 50% of the total ICS treatments (814,692 € on 1,658,164 €) is related to the ICS element, and so considered inappropriate costs. CONCLUSION: Economic differences between the two periods have highlighted a minor mean costs for Cohort 2, underlining an improvement in the adherence to the GOLD guidelines in the last period.

Background: COPD is one of the leading causes of morbidity and mortality. Pharmacotherapy improves quality of life and reduces exacerbations although low adherence with prescribed treatments may represent a barrier to optimal disease management. The first objective of this paper is to report the distribution of COPD patients according to GOLD categories, in a sample of patients from a cohort study in an area of the Latium region in Italy. The second objective is to evaluate the agreement between the distributions of severity obtained from the HCPs and the experts included in the study board (Board). Methods: COPD patients were given a card to collect demographic and clinical data at baseline. Information in those cards was independently evaluated by HCPs and Board to include each patient into one of the four GOLD categories. Results: In a sample of 187 stable COPD patients, 59% male, mean age 70 year, the distribution of GOLD categories according to the Board was: 6% A, 34% B, 2% C, and 58% D. A discrepancy in GOLD classification was observed between the study board and field-based HCPs, regarding more than 50% of the patients, with a clear trend to underestimate the frequency of patients in D level (21%) and to overestimate the frequency in C level (21%). Conclusions: These results describe for the first time the distribution of COPD patients in an Italian cohort according to the GOLD categories, with the highest frequencies in levels B and D. The misclassification from HCPs may impact the therapeutic approach and the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic Obstructive Pulmonary Disease (COPD) affects about 4.5% of the Italian population, representing one of most burdensome public health problems. Literature data report an annual health care expenditure ranging between € 1,300 and € 4,500 per patient, of which drug costs are a limited share. In 1998 the WHO started GOLD program in order to ameliorate COPD patient management. As a part of his program, periodically updated guidelines are produced with the aim of defining an efficient diagnostic-therapeutic pathway managed by a multidisciplinary team and based on the optimization of the use of drugs and diagnostic tests and the reduction of exposure to risk factors. Objective: to estimate the economic consequences of GOLD guidelines adoption in the Italian clinical practice. Methods: a decision analytic model capable of calculating the impact on the National Health Service budget of an ameliorated adherence to GOLD guidelines (GOLD GL strategy), basing on the needed variations in health care strategies on a defined patient cohort treated with the current approach (CURRENT strategy). The simulation runs on a cohort representing Italian COPD patients over 45 years who transit through 5 Markov health states (4 GOLD stages and death), according to patient characteristics (age, gender, FEV1), with a time horizon of 3 years. Stage-specific drug consumption of the CURRENT strategy is based on data of 3,113 patients collected by three Health Local Units involved in a larger clinical audit project. The consumption of other health resources, i.e. medical visits and inpatient care, is estimated based on a multicentre observational Italian study. The GOLD GL strategy includes spirometry-based staging on the totality of the simulated patients, the development of a therapeutic strategy including the redefinition of pharmacological therapy based on guideline recommendations and experts opinion, and variation of other health resources consumption based on observational data. Costs of health care resources are calculated based on published micro-costing analysis and current prices and tariffs. Results: the model estimates an adjunctive cost of about 19 million of Euros with the GOLD GL strategy, just for the the spirometry-based restaging of about 40% of the over 1 million and 250 thousand prevalent Italian COPD patients. Furthermore, in the first year of the analysis, the redefinition of the best clinical management strategy for all patients would cost about 100 million Euros, which are to be added to the more than 320 million Euros associated with adaptation of the GOLD stage specific pharmacological therapy, consisting mainly in a higher usage of long-acting beta agonist/corticosteroid combinations, only partially offset by the lower prescription of corticosteroid alone. Based on Italian observational data, the consumption of other health care resources with the GOLD GL strategy is reduced by about 44%, reflected in an estimated cost saving of more than 850 millions of Euros. For the first analysis year, the net cost saving associated with full GOLD guideline adoption is estimated equal to 410 millions of Euros; this value decreases by 11% and 21% respectively in the second and third years. Conclusion: our model estimates that the adoption of GOLD guidelines in the Italian clinical practice is associated to an average cost saving of about 300 Euros per patient/year.

Introduction: GOLD guideline recommendations are currently the "gold standard" for the treatment of COPD patients.Objectives: The objective of this analysis was to evaluate compliance with GOLD guidelines in managing COPD patients' treatment by general practitioners (GPs) and pulmonologists. Since inhaled corticosteroid (ICS) use is defined as inappropriate in mild and moderate COPD patients, special attention was paid to ICS therapy use in these classes.Methods: The study was based on the Italian GP database IMS Health Longitudinal Patient Database (IMS Health LPD) and on the Patient Analyzer specialist IMS Health database. The observed cohort included all patients with a diagnosis of COPD, aged 40 years or more, with at least one ATC R03 class prescription, visited by GPs and pulmonologists during four timeframes: October 2012 - March 2013 (cohort 1), April 2013 - September 2013 (cohort 2), October 2013 - March 2014 (cohort 3); April 2014 - September 2014 (cohort 4). Patients were classified into disease severity groups following 2008 GOLD guidelines, based on FEV1 value.Results: Cohorts were quite similar in size (about two thousand patients per cohort). Pulmonologists visited more severe patients than GPs. About 50% of GPs' mild and moderate patients received treatments containing inhaled corticosteroids. Pulmonologists were more adherent to guidelines, with smaller percentages of mild patients treated with therapies containing ICS (ranging from 19.0% to 30.1%). An improvement in adherence was observed during the four time periods, with a decrease in the use of therapies containing ICS in mild and moderate patients. In absolute terms, it emerged that GPs more often prescribe ICS improperly to patients in the mild and moderate severity classes than pulmonologists.Conclusion: Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists. [ABSTRACT FROM AUTHOR]

The 2017 Global Initiative for Chronic Obstructive Lung Disease guidelines for the evaluation and management of chronic obstructive pulmonary disease revise the assessment tool used to evaluate patients, implement a new pharmacologic algorithm focusing on escalation/de-escalation therapy, and recommend new combination inhaled medications. The guidelines also address nonpharmacologic treatments and the importance of identifying and properly managing comorbidities. This article highlights these important changes to clinical practice. [ABSTRACT FROM AUTHOR]

The article presents a research article titled "COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners." Topics discussed include assessment of Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, spirometry and non-pharmacological treatments by influenza vaccination, pulmonary rehabilitation, and pneumococcal vaccination, and obstructive elung disease tratment by severity levels.

Background. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) underlines that spirometry is the gold standard as the most reproducible, standardised, and objective way of measuring airflow limitation in the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD). However, studies undertaken in different countries have suggested a widespread underuse of spirometry by general practitioners to establish the diagnosis of COPD. Precise estimates of the prevalence of physician-diagnosed COPD in Italy are not currently available. In collaboration with the Italian Academy of General practitioners (SIMG) we have investigated the degree of use of spirometry to establish the diagnosis of COPD in Italy. Methods. A standardised questionnaire has been selfadministered to a sample of 2425 Italian general practitioners (representing 5% of all the Italian doctors involved in general practice). They have been chosen to cover each of the Italian counties. Results. The prevalence of physician-diagnosed COPD was found to be approximately 4%. However, 30% of general practitioners do not use spirometry to establish the diagnosis of COPD. The main reasons given for the failure to use spirometry are (i) that spirometry is not necessary for the diagnosis of COPD or (ii) there are logistical limitations to the access of the patients to lung function laboratories. Conclusions. This data suggests that contrary to GOLD Guidelines, in Italy, as with other countries, spirometry is not always used in the diagnosis of COPD. There is a clear necessity for further education initiatives targeted to this group of physicians.

Background: The aim of the study was to determine the values of hematological markers of anemia and of C-reactive protein (CRP) in patients with stable chronic obstructive pulmonary disease (COPD) in order to define the presence of anemia, degree of systemic inflammation and correlations between the analytes. Material and methods: The study included 150 COPD patients (FEV1 = 48 ± 21%) and 51 control subjects (FEV1 = 106 ± 15%). Pursuant to GOLD guidelines, the patients were divided into four subgroups and according to WHO criteria for anemia into two subgroups: subjects with and those without anemia. Serum CRP concentration was determined by immunoturbidimetric method and hematological markers were determined by flow cytometry. Results: No significant differences were found in the values of erythrocytes, hemoglobin and hematocrit either between the group of all COPD patients and control subjects or between GOLD subgroups and control subjects. Anemia was present in 24% of COPD patients. CRP concentration was significantly higher in the group of all COPD patients, in all GOLD subgroups (I, lIA, IIB and Ill) and in subgroups with and without anemia as compared to control subjects (P < 0.001 all). CRP specificity and sensitivity were determined by ROC analysis and showed good diagnostic accuracy for CRP in COPD patients. Correlation coefficient between CRP and hemoglobin and hematocrit values revealed a good negative correlation (r = -0.60 and r = -0.59, respectively; P <0.001 both) only in GOLD subgroup Ill. Conclusion: CRP concentration, a marker of systemic inflammation, was significantly higher in COPD patients and in all GOLD subgroups as compared to the control group. Good negative correlation was recorded between hematocrit and hemoglobin values and advanced inflammation (CRP concentration) in GOLD subgroup Ill. The rate of anemia was in agreement with literature data. [ABSTRACT FROM AUTHOR]

Comprehensive management of chronic obstructive pulmonary disease (COPD) includes proper assessment, monitoring of disease, reduction of risk factors, the management of stable COPD, and the prevention and management of exacerbations. The 2007 COPD guidelines from the Global Initiative for Chronic Obstructive Lung Disease address each of these aspects of COPD management in detail and provide evidence-based recommendations for patients and health-care professionals. Reduction of risk factors emphasizes the importance of smoking cessation and control of environmental indoor and outdoor pollutants. The management of COPD must be individualized. Aerosol administration of bronchodilators is the most effective method of reducing the work of breathing and alleviating dyspnea. Glucocorticosteroid therapy is recommended to reduce the frequency of exacerbations and improve health-related quality of life for patients with stage 3 and 4 COPD. Pulmonary rehabilitation proves effective in relieving symptoms, improving quality of life, and increasing patients' physical and emotional participation in activities of daily life. Oxygen therapy is essential for patients with substantial hypoxia. Patients with COPD and respiratory failure may benefit from noninvasive ventilation. Surgery may play a limited role in the management of selected patients with COPD. Since exacerbations influence lung function and clinical decline in patients with COPD and contribute to the cost of caring for this disease, efforts must be directed at prevention and management of exacerbations. In addition to controlled oxygen therapy, antimicrobials, brief courses of systemic corticosteroids and, on occasion, noninvasive or invasive mechanical ventilation may play a role. The role of respiratory therapists in the prevention, diagnosis, and management of stable COPD and exacerbations is absolutely essential if the goals of the 2007 Global Initiative for Chronic Obstructive Lung Disease guidelines are to be attained. [ABSTRACT FROM AUTHOR]

Summary: Background: COPD is a prevalent disease that generates high use of resources. The objective of this study was to quantify the economic consequences of non-adherence to GOLD guidelines for the management of COPD patients. Method: An economic model was generated to compare different scenarios of observed vs. expected costs of COPD treatment. A pooled analysis of data derived from a systematic review of studies describing treatment of COPD in Spain was combined with drug costs (using different assumptions) to obtain the observed cost of COPD treatment. An expected cost was obtained with the minimum and maximum treatment intensity derived from the GOLD recommendations. Results: A total of 8 studies were identified, comprising 6339 patients. Average medication cost of COPD patients was estimated as being between €1218 and €1314 per patient per year, higher than the ideal expected average cost (between €1007 and €1021 per patient/year). Thus, implementation of guidelines would result in a mean reduction of €198–€293 per patient/year. Sensitivity analysis showed that about 13% of patients had higher treatment costs than the maximum expected cost. This proportion is much higher in moderately/severely affected patients than in mildly affected patients (28.0% and 11.1%, respectively). Conclusions: Treatment of COPD allows for the identification of areas of inefficiency. An improvement in the adherence to the GOLD guidelines would imply potential savings of medication costs of about 20% of the observed costs. [Copyright &y& Elsevier]

The Global Obstructive Lung Disease (GOLD) guidelines suggest the potential use of combination bronchodilator therapy in patients with stage 11 or higher chronic obstructive pulmonary disease (COPD). Guidelines from the American Thoracic Society also mention that certain combinations of bronchodilators may prevent exacerbations. Combinations of several agents may benefit patients with COPD not only by improving lung function, but also by decreasing exacerbation rates and improving overall symptoms. A MEDLINE search was conducted to gather published data and clinical trial reports regarding the clinical effect of combining bronchodilators in the treatment of COPD. Agents such as oxitropium, which is not available in the United States, were not included in the analysis. Although the data are somewhat limited, trials suggest many potential benefits for combination bronchodilator therapy in patients with COPD. Information on combining long-acting anticholinergic drugs with long-acting β2-agonists is scarce, but the combination of two long-acting agents may provide additional benefits by improving patient compliance with prescribed regimens. More studies evaluating outcomes in patients with COPD may help solidify the potential benefits of combination inhaled bronchodilator therapy. [ABSTRACT FROM AUTHOR]

Question of the Study. To assess the impact of prescribing pulmonary drugs according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines on direct costs in stable chronic obstructive pulmonary disease (COPD). Patients and Methods. A total of 560 ambulatory COPD patients completed a specific questionnaire that included data regarding drug therapy. Severity was graded according to the British Thoracic Society (BTS) criteria and appropriateness of pharmacological treatment according to GOLD guidelines. Results. Annual direct costs were 1,657 EUR in stage I, 2,425 EUR in stage II, and 3,303 EUR in stage III. The mean direct costs was 2,061 EUR (38% corresponded to drug therapy). Medication accounted for 43%, 37.6%, and 28.4% of total direct costs for stage I, II, and III, respectively. Inhaled steroids and long‐acting β2‐agonists accounted for 78%, 76%, and 75% of total drugs costs in stages I, II, and III, respectively. Drug therapy which was not in accordance with guidelines accounted for 78.7% and 54% of total drug costs in stages I and II, respectively. Most patients with severe disease were treated adequately. Answer to the Question. Pharmacologic treatment has a great impact on direct medical costs in stable COPD. According to GOLD guidelines, patients with mild or moderate COPD are frequently treated with nonrecommended drugs. [ABSTRACT FROM AUTHOR]

Objectives: Chronic obstructive pulmonary disease is a large and increasing problem in low- and middle-income countries; Nepal is no exception. We aimed to obtain information on patient characteristics and the level of care provided to patients admitted for acute exacerbation of chronic obstructive pulmonary disease in two Nepalese hospitals and to compare the given care with the Global Initiative for Chronic Obstructive Lung Disease guidelines., Methods: This was a cross-sectional, observational, descriptive study. All patients admitted to two Nepalese hospitals due to acute exacerbation of chronic obstructive pulmonary disease between 18 February and 5 April 2019 were asked to participate., Results: In total, 108 patients with a median age of 70 years participated. Fifty-three (42.7%) were male, 80 (74.8%) were former smokers, and 46 (45.1%) were farmers. Using the Global Initiative for Chronic Obstructive Lung Disease A-D classification, 97 (90.6%) of the patients were classified in group D. All the patients received supplementary oxygen treatment and 103 (95.4%) were treated with short-acting beta2 agonists. A total of 105 (97.2%) patients received antibiotics, and 80 (74.5%) received systemic corticosteroids. The majority was discharged with triple therapy including long-acting muscarinic antagonist, long-acting beta2 agonist, and inhaled corticosteroids, and 72 (75.8%) were discharged with long-term oxygen treatment., Conclusion: All elements of the Global Initiative for Chronic Obstructive Lung Disease guidelines were applied. However, due to a lack of information, it cannot be concluded whether the treatment was provided on the correct indications. The average patient received almost all the treatment alternatives available. This might indicate a very sick population or over-treatment., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)