Guidelines versus clinical practice in the treatment of chronic obstructive pulmonary disease

The main purpose of this study was to assess whether pharmacological treatments prescribed by respiratory physicians to patients with chronic obstructive pulmonary disease (COPD) were consistent with the guidelines. The treatments prescribed by respiratory physicians to 631 consecutive patients with COPD, compared to 879 asthmatics were prospectively recorded. All subjects underwent peak expiratory flow rate measurement, spirometry and assessment of recent evolution and dyspnoea (visual analogue and Medical Research Council scales). Patients with COPD received more treatments than asthmatics (mean+/-SD: 2.6+/-0.5 versus 2.2+/-0.4, p<0.0001). Treatments administered to patients with COPD were beta2-agonists in 78% (versus 94% in asthmatics), anticholinergic agents (AC) in 56% (versus 16% in asthma), methylxanthines in 31% (versus 15% in asthma) and inhaled corticosteroids in 76% (versus 85% in asthma). Intensity of treatment was influenced by disease severity for all treatments except AC. In conclusion, pharmacological treatment of chronic obstructive pulmonary disease by respiratory physicians is only partially consistent with current guidelines, with a high proportion of inhaled corticosteroid prescriptions and a relative under-use of anticholinergic agents; this most likely reflects the persistent uncertainties of physicians, and emphasizes that more efforts are required to improve implementation of chronic obstructive pulmonary disease guidelines and assess the efficacy and cost-effectiveness of recommended strategies.