Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world

Zaurbek Aisanov1,*, Chunxue Bai2,*, Otto Bauerle3,*, Federico D Colodenco4,*, Charles Feldman5,6,*, Shu Hashimoto7,*, Jose Jardim8,*, Christopher KW Lai9,*, Rafael Laniado-Laborin10,*, Gilbert Nadeau11,*, Abdullah Sayiner12,*, Jae Jeong Shim13,*, Ying Huang Tsai14,*, Richard D Walters11,*, Grant Waterer15,* 1Pulmonology Research Institute, Moscow, Russia; 2Department of Pulmonary Medicine, Fudan University, Shanghai, People's Republic of China; 3Centro Médico de las Américas, Mérida, Yucatán, Mexico; 4Hospital de Rehabilitación Respiratoria "María Ferrer," Buenos Aires, Argentina; 5Department of Internal Medicine, Charlotte Maxeke Johannesburg Hospital, Johannesburg, South Africa; 6Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 7Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; 8Federal University of São Paulo, São Paulo, Brazil; 9Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; 10Faculty of Medicine, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico; 11Medical Affairs, GlaxoSmithKline, Brentford, UK; 12Department of Chest Diseases, Ege University Medical School, Izmir, Turkey; 13Department of Pulmonology, Guro Hospital, Korea University Medical Center, Seoul, South Korea; 14Department of Respiratory Care Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan; 15School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia*ICON group (International COPD Network), listed in alphabetical orderAbstract: Chronic obstructive pulmonary disease (COPD) is a multicomponent disorder that leads to substantial disability, impaired quality of life, and increased mortality. Although the majority of COPD patients are first diagnosed and treated in primary care practices, there is comparatively little information on the management of COPD patients in primary care. A web-based pilot survey was conducted to evaluate the primary care physician's, or general practitioner's (GP's), knowledge, understanding, and management of COPD in twelve territories across the Asia-Pacific region, Africa, eastern Europe, and Latin America, using a 10-minute questionnaire comprising 20 questions and translated into the native language of each participating territory. The questionnaire was administered to a total of 600 GPs (50 from each territory) involved in the management of COPD patients and all data were collated and analyzed by an independent health care research consultant. This survey demonstrated that the GPs' understanding of COPD was variable across the territories, with large numbers of GPs having very limited knowledge of COPD and its management. A consistent finding across all territories was the underutilization of spirometry (median 26%; range 10%–48%) and reliance on X-rays (median 14%; range 5%–22%) for COPD diagnosis, whereas overuse of blood tests (unspecified) was particularly high in Russia and South Africa. Similarly, there was considerable underrecognition of the importance of exacerbation history as an important factor of COPD and its initial management in most territories (median 4%; range 0%–22%). Management of COPD was well below guideline-recommended levels in most of the regions investigated. The findings of this survey suggest there is a need for more ongoing education and information, specifically directed towards GPs outside of Europe and North America, and that global COPD guidelines appear to have limited reach and application in most of the areas studied.Keywords: COPD, questionnaire, survey, guidelines