[Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols]

Abstract

Objective: The aims of this study were to identify the drug treatment protocols applied by primary care physicians or pneumologists for patients with stable chronic obstructive pulmonary disease (COPD) in Spain, to determine the agreement between prescription practices and current recommendations and to assess differences between the two levels of patient care.

Patients and methods: The study was observational, descriptive and multicenter. A stratified random sample of patients treated by family physicians or pneumologists was taken for every region in Spain.

Results: Five hundred sixty-eight (63.2%) of the 898 subjects fulfilled COPD diagnostic criteria; 100 were treated by primary care physicians and 460 by pneumologists. In 8 cases the caregiver was unknown. Obstruction was mild-to-moderate in 144 cases and severe in 416. The drugs most commonly prescribed were ipratropium bromide (77.8%), inhaled short-acting beta(2) agonists (65.8%), inhaled corticosteroids (61.0%), long-acting beta(2) agonists (46.4%) and theophyllines (41.3%). Primary care physicians prescribed inhaled short-acting beta 2-agonists most often, whereas pneumologists prescribed anticholinergics most often. In the primary care setting, no differences in treatment protocols were observed based on severity of COPD, degree of dyspnea or quality of life. More consistent differences were seen in treatment by pneumologists. In both settings, prescription was more frequently given when COPD was severe. The most commonly prescribed inhalation device was the Turbuhaler in primary care and the pressurized canister in pneumology.

Conclusions: Treatments prescribed for COPD patients do not follow current guidelines strictly, particularly in the primary care setting. Different prescription protocols are used at the different levels of patient care.