The implementation of GOLD 2011 among pulmonary specialists in the Czech Republic

Background: Physicians knowledge of global COPD guidelines varies widely across countries. Purpose: The main objective of this survey was to assess the awareness and implementation of GOLD 2011 strategy. Methods: Multicentre cross-sectional study of COPD treatment practice among Czech pulmonology specialists. The overall study consisted of two types of surveys; the general questionnaire and the patient-specific electronic case report form (eCRF). Results:Data from 144 pulmonologists were obtained (Oct-Dec 2012). In total 143 (99.3%) of all respondents indicated the GOLD 2011 guidelines as leading guidelines in their practice, often along with another: Czech guidelines (83.3%) and the ERS/ATS standards (50.7%). In total 1355 consecutive patients (68,5y) were reported into the eCRF. Misclassification was apparent in 32.8% of reported cases. The most important reason for GOLD misclassification was incorrect assessment of symptoms. Evaluating the trends closely, 23.9% of all cases were underestimated and 8.9% of all cases were overestimated. The greatest error rate was observed in a group of specialists with more than 120 patients per month. Considering that the observed classification into A, B, C and D as pronounced by specialists, 19.5% of patients have been over-prescribed ICS while 12.2% had ICS under-prescribed. Female specialists failed in correct prescription more frequently than male specialists (33.6% vs. 27.3%), predominantly by over-prescribing ICS. Conclusion: Although there seems to be high awarness of GOLD 2011, the implementation shows rather insufficient. There is an obvious tendency towards underclassification of patients and simultaneous overtreatment of COPD patients.