How Ignoring COPD Guidelines Helped Veterans

LONG ISLAND, NY — Failing to follow international guidelines on treatment of chronic obstructive pulmonary disease (COPD) isn’t always bad medicine, a new study reported.

The report published in the International Journal of Chronic Obstructive Pulmonary Disease discussed the results of a study analyzing data on 900 COPD patients from 2005 to 2010.

Researchers from the Northport VAMC in Long Island, NY, and colleagues found that 44% of the patients in the study were under-treated by receiving a medication regimen more appropriate for patients with less-severe disease, according to the Global Initiative for Obstructive Lung Disease (GOLD) clinical guidelines of the time. In fact, only 19% of the patients were treated appropriately.1

The GOLD guidelines grouped patients into four categories based strictly on the amount of airway blockage indicated by spirometric lung function tests in the pulmonary lab. Yet, those patients who were undertreated had far fewer exacerbations, on average, than those whose treatment was in line with the guidelines.

“When we started the work on this paper, it was 2010,” explained study co-leader Hussein Foda, MD. “Our expectation was that this was going to show that when physicians didn’t follow the guidelines, patients would do worse. And when they did follow the guidelines, patients would do better.”

(A year after the study ended, the GOLD group revised its guidelines to take into account patients’ exacerbation rates.)

“What happened was that the physicians here in the VA were adjusting their treatments, depending on what happened with the patients. If the patients did not get exacerbations, their doctors reduced their medication, even though it was recommended in the guidelines to increase,” explained Foda, who is also a professor of medicine at Stony Brook University.

He said there’s a larger lesson to be learned from the study.

Foda emphasized that clinical guidelines are generally a good thing, adding, “in a system like VA, they are very useful.” On the other hand, he pointed out that “you’d better make sure that guidelines make sense. They have to be studied, and they cannot be static. In this case, the GOLD folks realized there was a need to adjust the guidelines.”

  1. Foda HD, Brehm A, Goldsteen K, Edelman NH. Inverse relationship between nonadherence to original GOLD treatment guidelines and exacerbations of COPD. Int J Chron Obstruct Pulmon Dis. 2017 Jan 6;12:209-214. doi: 10.2147/COPD.S119507. PubMed PMID: 28123293; PubMed Central PMCID: PMC5230726.

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