Chronic obstructive pulmonary disease in ambulatory practice

Abstract

Quality of outpatient management of patients with chronic obstructive pulmonary disease (COPD) and ways to improve it have been studied in this trial. The study included analysis of 560 medical recorders of outpatients followed up in one and the same outpatient clinic by one and the same physician for 5 to 10 yrs and who were currently newly diagnosed for COPD, epidemiological investigation using questionnaire and spirometry in all patients attending the outpatient clinic, and organization of educational COPD center for physicians, nurses and patients. We assessed concordance of the patients' management according to medical records to national guidelines. Most frequent discrepancies were inaccurate recording of the patient's symptoms and history, incomplete and inadequate examination, incorrect diagnosis, inadequate therapy. Functional disorders were not estimated in 95.9 % of the patients, COPD stage was not determined in 100 % of the cases, severity was not assessed in 83.9 %, and 70.7 % of the patients were not diagnosed for complications and exacerbations of the disease. Inhaled bronchodilators were not administered in 41.9 % of the patients, 90 % of the patients were inadequately treated with antibiotics, 100 % of the patients were not vaccinated. The main reasons for this mismatching were thought to be poor awareness of COPD by physicians, lack of pneumologists in outpatient clinics, and insufficient technical provision of the outpatients clinics with spirographs, oxymeters, etc. The epidemiological examination involved 8 672 patients, among them 38 % reported respiratory symptoms and 24 % had ventilatory disorders. COPD was firstly diagnosed in 768 patients. Implementation of educational programmes have led to necessary functional investigations to be used twice more frequent.