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      Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world

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          Chronic obstructive pulmonary disease (COPD) is a multicomponent disorder that leads to substantial disability, impaired quality of life, and increased mortality. Although the majority of COPD patients are first diagnosed and treated in primary care practices, there is comparatively little information on the management of COPD patients in primary care. A web-based pilot survey was conducted to evaluate the primary care physician’s, or general practitioner’s (GP’s), knowledge, understanding, and management of COPD in twelve territories across the Asia-Pacific region, Africa, eastern Europe, and Latin America, using a 10-minute questionnaire comprising 20 questions and translated into the native language of each participating territory. The questionnaire was administered to a total of 600 GPs (50 from each territory) involved in the management of COPD patients and all data were collated and analyzed by an independent health care research consultant. This survey demonstrated that the GPs’ understanding of COPD was variable across the territories, with large numbers of GPs having very limited knowledge of COPD and its management. A consistent finding across all territories was the underutilization of spirometry (median 26%; range 10%–48%) and reliance on X-rays (median 14%; range 5%–22%) for COPD diagnosis, whereas overuse of blood tests (unspecified) was particularly high in Russia and South Africa. Similarly, there was considerable underrecognition of the importance of exacerbation history as an important factor of COPD and its initial management in most territories (median 4%; range 0%–22%). Management of COPD was well below guideline-recommended levels in most of the regions investigated. The findings of this survey suggest there is a need for more ongoing education and information, specifically directed towards GPs outside of Europe and North America, and that global COPD guidelines appear to have limited reach and application in most of the areas studied.

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          Most cited references 28

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.

           W MacNee,  ,  B Celli (2004)
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            Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial.

            The beneficial effects of pharmacotherapy for chronic obstructive pulmonary disease (COPD) are well established. However, there are few data for treatment in the early stages of the disease. We examined the effect of tiotropium on outcomes in a large subgroup of patients with moderate COPD. The Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) study was a randomised, double-blind, placebo-controlled trial undertaken in 487 centres in 37 countries. 5993 patients aged 40 years or more with COPD were randomly assigned to receive 4 years of treatment with either once daily tiotropium (18 microg; n=2987) or matching placebo (n=3006), delivered by an inhalation device. Randomisation was by computer-generated blocks of four, with stratification according to study site. In a prespecified subgroup analysis, we investigated the effects of tiotropium in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II disease. Primary endpoints were the yearly rates of decline in prebronchodilator forced expiratory volume in 1 s (FEV(1)) and in postbronchodilator FEV(1), beginning on day 30 until completion of double-blind treatment. The analysis included all patients who had at least three measurements of pulmonary function. This study is registered with, number NCT00144339. 2739 participants (mean age 64 years [SD 9]) had GOLD stage II disease at randomisation (tiotropium, n=1384; control, n=1355), with a mean postbronchodilator FEV(1) of 1.63 L (SD 0.37; 59% of predicted value). 1218 patients in the tiotropium group and 1157 in the control group had three or more measurements of postbronchodilator pulmonary function after day 30 and were included in the analysis. The rate of decline of mean postbronchodilator FEV(1) was lower in the tiotropium group than in the control group (43 mL per year [SE 2] vs 49 mL per year [SE 2], p=0.024). For prebronchodilator pulmonary function, 1221 patients in the tiotropium group and 1158 in the control group had three or more measurements and were included in the analysis. The rate of decline of mean prebronchodilator FEV(1) did not differ between groups (35 mL per year [SE 2] vs 37 mL per year [SE 2]; p=0.38). Health status, measured with the St George's Respiratory Questionnaire, was better at all timepoints in the tiotropium group than in the control group (p
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              Global strategy for the diagnosis, management and prevention of COPD


                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                05 April 2012
                : 7
                : 271-282
                [1 ]Pulmonology Research Institute, Moscow, Russia
                [2 ]Department of Pulmonary Medicine, Fudan University, Shanghai, People’s Republic of China
                [3 ]Centro Médico de las Américas, Mérida, Yucatán, Mexico
                [4 ]Hospital de Rehabilitación Respiratoria “María Ferrer,” Buenos Aires, Argentina
                [5 ]Department of Internal Medicine, Charlotte Maxeke Johannesburg Hospital, Johannesburg, South Africa
                [6 ]Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
                [7 ]Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
                [8 ]Federal University of São Paulo, São Paulo, Brazil
                [9 ]Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
                [10 ]Faculty of Medicine, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico
                [11 ]Medical Affairs, GlaxoSmithKline, Brentford, UK
                [12 ]Department of Chest Diseases, Ege University Medical School, Izmir, Turkey
                [13 ]Department of Pulmonology, Guro Hospital, Korea University Medical Center, Seoul, South Korea
                [14 ]Department of Respiratory Care Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
                [15 ]School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
                Author notes
                Correspondence: Richard Walters, GlaxoSmithKline, Asia Pacific, Japan and Emerging Markets, Medical Affairs, GSK House, 980 Great West Road, Brentford, TW8 9GS, UK, Tel +44 208 047 4765, Fax +44 208 047 6921, Email richard.d.walters@

                ICON group (International COPD Network), listed in alphabetical order

                © 2012 Aisanov et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Original Research

                Respiratory medicine

                questionnaire, survey, guidelines, copd


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