Assessment of prescription practices according to international chronic obstructive pulmonary disease guidelines on Egyptian doctors

Nasr H Kahlil, Hossam M Abdel-Hamid, Yasser M Mohammed

Egyptian Journal of Bronchology 2017 11(3):193-202

Background and objectives Chronic obstructive pulmonary disease (COPD) is defined as ‘a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients’. Its pulmonary component is characterized by airflow limitation that is not fully reversible. There is a wide variation in physicians’ management of the condition, and this may be ascribed to nonadherence to the guidelines. Adherence to COPD guidelines in clinical practice in most countries is not satisfactory. Aim The aim of this work is to assess the prescription pattern and clinical practice attitudes toward Egyptian COPD patients managed by chest physicians and internal medicine physicians in Abbassia Chest Hospital and Ain Shams University Hospitals during the period from February 2013 to January 2014. Patients and methods In this study, one questionnaire was specifically directed to physicians. Sixty doctors were at Abbassia Chest Hospital, 63 at Ain Shams University Hospitals, and six doctors at Ministry Hospitals. Doctors were chest residents (29.5%), chest physicians with masters degree (33.3%), chest physicians with MD (13.2%), or internal medicine doctors (34%). Results Only 53 physicians performed spirometry. Most of the physicians prescribed antibiotics and systemic steroids to their patients in exacerbations. Macrolides, cephalosporins, and quinolones were the most commonly prescribed antibiotics by physicians in COPD exacerbations. Only 46 physicians used noninvasive ventilation in hypercapnic respiratory failure. Only 33 physicians were following GOLD 2013 guidelines. Conclusion Doctors’ awareness of guidelines is suboptimal; major deviations from the GOLD guidelines were in the form of underuse of spirometry, smoke cessation programs, and of noninvasive ventilation in exacerbations and lack of use of pulmonary rehabilitation treatment.

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