Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study

Abstract

Carlos Cabrera,1 Ciro Casanova,2 Yolanda Martín,3 Virginia Mirabal,3 María del Carmen Sánchez,4 Felisa Álvarez,5 Gabriel Juliá,1 Pedro Cabrera-Navarro,1 Miguel Ángel García-Bello,6 José María Marín,7 Juan Pablo de-Torres,8 Miguel Divo,9 Bartolomé Celli9 1University Hospital of Gran Canaria Dr Negrín, Respiratory Service, Las Palmas de Gran Canaria, Spain; 2University Hospital Nuestra Señora de la Candelaria, Respiratory Service, Santa Cruz de Tenerife, Spain; 3Arucas Health Center, Primary Care Las Palmas de Gran Canaria, Spain; 4Cueva Torres Health Center, Primary Care Las Palmas de Gran Canaria, Spain; 5La Feria Health Center, Primary Care Las Palmas de Gran Canaria, Spain; 6University Hospital of Gran Canaria Dr Negrín, Investigation Unit, Las Palmas de Gran Canaria, Spain; 7University Hospital Miguel Servet, Respiratory Service, Zaragoza, Spain; 8Navarra University Clinic, Respiratory Service, Pamplona, Spain; 9Brigham and Women’s Hospital, Pulmonary and Critical Care Service, Boston, MA, USA Introduction: Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline.Methods: We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations.Results: We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort.Conclusion: A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative. Keywords: COPD, treatment, algorithm, primary care

Keywords

• COPD
• Treatment
• algorithm