Journal List > Tuberc Respir Dis > v.64(2) > 1001193

TOOLS
Park, Choi, Kim, Kim, Lee, Kang, Shin, Lee, Lee, Kim, Lim, Park, Jung, Kim, Shin, and Yoo: Survey of COPD Management among the Primary Care Physicians in Korea
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 64(2): 109-124.

Published online: 29 February 2008

DOI: https://doi.org/10.4046/trd.2008.64.2.109

Survey of COPD Management among the Primary Care Physicians in Korea

Myung Jae Park, M.D.1, Cheon Woong Choi, M.D.1, Seung Joon Kim, M.D.2, Young Kyoon Kim, M.D.2, Sung Yong Lee, M.D.3, Kyung Ho Kang, M.D.3, Kyeong-Cheol Shin, M.D.4, Kwan Ho Lee, M.D.4, Jin Hwa Lee, M.D.5, Yu-Il Kim, M.D.6, Sung-Chul Lim, M.D.6, Yong Bum Park, M.D.7, Ki-Suck Jung, M.D.7, Tae-Hyung Kim, M.D.8, Dong Ho Shin, M.D.8, Jee-Hong Yoo, M.D.1

Study for the Development and Dissemination of the COPD Guidelines, Clinical Research Center for Chronic Obstructive Airway Disease

1Department of Internal Medicine, Kyung Hee University, Korea.

2Department of Internal Medicine, The Catholic University of Korea, Korea.

3Department of Internal Medicine, Korea University, Seoul, Korea.

4Department of Internal Medicine, Yeungnam University, Daegu, Korea.

5Department of Internal Medicine, Ewha Womans University, Seoul, Korea.

6Department of Internal Medicine, Chonnam Univeristy, Gwangju, Korea.

7Department of Internal Medicine, Hallym University, Chuncheon, Korea.

8Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Address for correspondence: Jee-Hong Yoo, M.D. Department of Pulmonary and Critical Care Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, 149, Sangil-dong, Gangdong-gu, Seoul 134-727, Korea. Phone: 82-2-440-7701, Fax: 82-2-440-7707, honglung@chollian.net

Received 3 January 2008       Accepted 29 January 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

The incidence of chronic obstructive pulmonary disease (COPD) is increasing and the disease is becoming an important cause of morbidity and mortality worldwide. It is important to implement evidence-based guidelines by primary care physicians (PCPs) to establish qualified management of COPD patients. The aim of this survey is to investigate the pattern of COPD management among PCPs and to apply it to the development of Korean COPD guidelines.

Methods

A web-based questionnaire was prepared that consisted of 25 questions on the pattern of COPD management. A total of 217 PCPs participated in the survey from June 2006 to May 2007.

Results

Many PCPs (61.8%) possessed a spirometer, but the application rate was relatively low (35.8%) and more than half of the COPD patients (57%) did not receive a diagnosis based on spirometry. Administration of oral medication was preferred than the administration of inhaled medication for both stable COPD and acutely exacerbated COPD. More than 90% of the PCPs endorsed educational measures to quit smoking and vaccinate against influenza. It was noted that 56.7% of the PCPs were aware of the GOLD guidelines, but only 7.3% tended to fully implement the recommendations of the guidelines in daily practice.

Conclusion

The results of the survey indicate that despite the high awareness rate of the current COPD guidelines, deficits exist among the PCPs with respect to the diagnosis and treatment of COPD. The results of this survey should be applied for the development of new COPD guidelines in order to decrease the discrepancy between the guidelines and the daily practice of the PCPs.

Keywords: Chronic obstructive pulmonary disease, Health surveys, Guideline

Figures and Tables

Figure 1
Screen capture of web based survey.
trd-64-109-g001
Figure 2
Distribution of the length of time in practice.
trd-64-109-g002
Table 1
Characteristics of the survey participants
trd-64-109-i001
Table 2
Result of survey for the diagnosis of COPD (I)
trd-64-109-i002
Table 3
Result of survey for the diagnosis of COPD (II)
trd-64-109-i003
Table 4
Result of survey for the diagnosis of COPD (III)
trd-64-109-i004
Table 5
Result of survey for the management of COPD
trd-64-109-i005
Table 6
Prescribing pattern of inhaled medication for stable COPD
trd-64-109-i006

SABA: short acting β2 agonist; LABA: long acting β2 agonist; SAAC: short acting anticholiergics; LAAC: long acting anticholiergics; ICS: inhaled corticosteroid.

*total click number of selected medication/total click number of all medication×100, †total click number of always, more than 50%/total click number of selected medication×100.

Table 7
Prescribing pattern of oral medication for stable COPD
trd-64-109-i007

LRA: leukotriene receptor antagonist.

*total click number of selected medication/total click number of all medication×100, †total click number of always, more than 50%/total click number of selected medication×100.

Table 8
Prescribing pattern of inhaled medication for COPD acute exacerbation
trd-64-109-i008

SABA: short acting β2 agonist; LABA: long acting β2 agonist; SAAC: short acting anticholiergics; LAAC: long acting anticholiergics; ICS: inhaled corticosteroid.

*total click number of selected medication/total click number of all medication×100, †total click number of always, more than 50%/total click number of selected medication×100.

Table 9
Prescribing pattern of oral medication for COPD acute exacerbation
trd-64-109-i009

LRA: leukotriene receptor antagonist.

*total click number of selected medication/total click number of all medication×100, †total click number of always, more than 50%/total click number of selected medication×100.

Table 10
Prescribing pattern of antibiotics in patients with acute exacerbation of COPD
trd-64-109-i010
Table 11
Result of survey about the risk factor for COPD
trd-64-109-i011
Table 12
Result of the survey about the COPD patient education
trd-64-109-i012
Table 13
Result of survey about GOLD guideline
trd-64-109-i013
Table 14
Current status of the spirometer according to the type of facility*
trd-64-109-i014

*according to the data from National Health Insurance Corporation, Korea. July 2007.

References

1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001. 163:1256–1276.
2. Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004. 59:Suppl 1. 1–232.
3. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997. 349:1498–1504.
4. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007. 370:765–773.
5. Kim DS, Kim YS, Jung KS, Chang JH, Lim CM, Lee JH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. Am J Respir Crit Care Med. 2005. 172:842–847.
6. Glaab T, Banik N, Rutschmann OT, Wencker M. National survey of guideline-compliant COPD management among pneumologists and primary care physicians. COPD. 2006. 3:141–148.
7. Calverley PM, Walker P. Chronic obstructive pulmonary disease. Lancet. 2003. 362:1053–1061.
8. Calverley PM, Wedzicha JA. Chronic obstructive pulmonary disease past, present and future. Thorax. 2007. 62:1026–1027.
9. Sullivan SD, Ramsey SD, Lee TA. The economic burden of COPD. Chest. 2000. 117:5S–9S.
10. Menezes AM, Perez-Padilla R, Jardim JR, Muino A, Lopez MV, Valdivia G, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005. 366:1875–1881.
11. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007. 370:741–750.
12. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007. 176:532–555.
13. Lee EK. Implementation status of asthma management guideline in Korea . Health and Welfare(Bo-Kun-Bok-JI) Foru. 2004. 10:45–55.
14. Rutschmann OT, Janssens JP, Vermeulen B, Sarasin FP. Knowledge of guidelines for the management of COPD: a survey of primary care physicians. Respir Med. 2004. 98:932–937.
15. Hobbs FD, Erhardt L. Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract. 2002. 19:596–604.
16. Daly C, Clemens F, Lopez-Sendon JL, Tavazzi L, Boersma E, Danchin N, et al. The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur Heart J. 2006. 27:1298–1304.
17. Fretheim A, Schunemann HJ, Oxman AD. Improving the use of research evidence in guideline development: 15. Disseminating and implementing guidelines. Health Res Policy Syst. 2006. 4:27.
18. Johannessen A, Omenaas E, Bakke P, Gulsvik A. Incidence of GOLD-defined chronic obstructive pulmonary disease in a general adult population. Int J Tuberc Lung Dis. 2005. 9:926–932.
19. Lindberg A, Jonsson AC, Ronmark E, Lundgren R, Larsson LG, Lundback B. Prevalence of chronic obstructive pulmonary disease according to BTS, ERS, GOLD and ATS criteria in relation to doctor's diagnosis, symptoms, age, gender, and smoking habits. Respiration. 2005. 72:471–479.
20. Dales RE, Vandemheen KL, Clinch J, Aaron SD. Spirometry in the primary care setting: influence on clinical diagnosis and management of airflow obstruction. Chest. 2005. 128:2443–2447.
21. Buffels J, Degryse J, Heyrman J, Decramer M. Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO Study. Chest. 2004. 125:1394–1399.
22. Poels PJ, Schermer TR, van Weel C, Calverley PM. Spirometry in chronic obstructive pulmonary disease. BMJ. 2006. 333:870–871.
23. Decramer M, Bartsch P, Pauwels R, Yernault JC. Management of COPD according to guidelines. A national survey among Belgian physicians. Monaldi Arch Chest Dis. 2003. 59:62–80.
24. Maleki-Yazdi MR, Lewczuk CK, Haddon JM, Choudry N, Ryan N. Early detection and impaired quality of life in COPD GOLD stage 0: a pilot study. COPD. 2007. 4:313–320.
25. Tashkin D, Kanner R, Bailey W, Buist S, Anderson P, Nides M, et al. Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial. Lancet. 2001. 357:1571–1575.
TOOLS
Similar articles