Implementation of COPD phenotypes in real life

Background: The Czech Pneumological and Phthisiological Society (CPPS) established (2013) national guidelines based on simultaneous use of GOLD principles and COPD phenotypes. The real implementation of this into routine practice of respiratory specialists is unclear. Aims: The objective of this study was to examine the degree of use of phenotypically based approach among Czech pneumologists. Method: In order to achieve this goal, a multicenter, cross-sectional study was conducted, consisting of a general questionnaire and patient-specific forms (Apr/Jul 14). Results: The data regarding 1323 consecutive COPD subjects (413 males, FEV 1 52.6%, 18.3% non-smokers) from 86 specialists (23% of all Czech respiratory physicians) were obtained, 43 of which worked out of hospitals. The majority declared routine use of GOLD categories and phenotypes. Simple clinical (without computer tomography CT) assessment of phenotypes showed 16.2% ACOS, 62.3% non-excerbators, 18.4% and 3.2% exacerbators with and without bronchitis. More sophisticated procedure of 407 participants (with CT) found emphysema in 65.4% and bronchiectasis in 15.7%. Long-term therapy of COPD consisted of LAMA 57.5%, LABA 46.8%, ICS 46.2%, theophyllines 45.7%, mucolytics 15.7%, roflumilast 8.3% and antibiotics 1% (often out of recommendations). Vaccination, rehabilitation, long-term oxygen, non-invasive ventilation, LVRS, and BVR were used in 15.7%, 5.5%, 5,3%, 0.6%, 0.4% and 0.1% of cases respectively. Conclusion: The self-reported acknowledgement of the phenotypically centered guidelines among specialist was satisfactory. Nevertheless, the real-life implementation of these guidelines was insufficient as treatment habits did not-fully reflect the phenotypical approach.