Comparison of COPD Management Practices with Expert Recommendations among Pulmonologists and Primary Care Providers

Abstract

Rationale: Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD in 2017 recommended several important changes regarding assessment of exacerbation risk and selection of pharmacotherapy (Vogelmeier CF et al, Am J Respr Crit Care Med 2017;195(5):557-582). The objective of this study was to assess knowledge, competence and attitudes among pulmonologists and primary care providers (PCPs) regarding the interpretation of these recommendations using case-based scenarios. Methods: A continuing medical education (CME)-certified program consisting of 26 multiple-choice questions derived from GOLD 2017 recommendations, was hosted on the Medscape Education website. Participant responses were collected from July 25 to August 20, 2017. Confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Findings: 209 pulmonologists and 220 PCPs participated. 51% of pulmonologists and 81% of PCPs were unaware that GOLD 2017 no longer considers lung function for staging and treatment selection. For a mild COPD case, 33% of pulmonologists and 33% of PCPs chose no pharmacotherapy. For moderate-severe COPD, 35% of pulmonologists and 39% of PCPs would consider ICS use outside of GOLD recommendations; 38% of pulmonologists and 46% of PCPs would maintain triple therapy in a symptomatic exacerbation-free patient versus a de-escalation strategy. Conclusion: Significant gaps regarding GOLD 2017 recommended practices were identified among both groups. Educational interventions tailored to specific needs are warranted to address these gaps.