J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 8, August 2019, pages 556-562

Outpatient Management of Chronic Obstructive Pulmonary Disease: Physician Adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease Guidelines and its Effect on Patient Outcomes

Figure 1. Comparison of the distribution of exacerbations for patients treated according to the GOLD guidelines (n = 32) versus those who were not (n = 57). GOLD-adherent patients had outliers in their distribution of exacerbations. The star represents one subject who experienced six exacerbations during the 1-year period. The asterisk represents two subjects who experienced five exacerbations. The circle represents one subject who experienced three exacerbations.

**Table 1.** Demographic and Clinical Characteristics
Variable	Frequency (n = 158)
SD: standard deviation; COPD: chronic obstructive pulmonary disease; GOLD: Global Initiative for Obstructive Lung Disease.
Age (years, mean (SD))	71.58 (12.9)
Body mass index (kg/m², mean (SD))	27.61 (6.67)
Gender
Male, n (%)	70 (44.3)
Female, n (%)	88 (55.7)
Race
White, n (%)	122 (77.2)
Black, n (%)	21 (13.3)
Asian, n (%)	8 (5.1)
Hispanic, n (%)	7 (4.4)
Social
Smoking (n, %)	152 (96.2)
Diagnosis
COPD (n, %)	150 (94.9)
Emphysema (n, %)	103 (65.2)
Pulmonary follow-up (n, %)	88 (55.7)
Spirometric diagnosis
COPD (n, %)	89 (56.3)
Pulmonary follow-up (n, %)	69 (78.4)
No pulmonary follow-up (n, %)	20 (21.6)
GOLD criteria calculated (n, %)	89 (56.3)
Management per GOLD (n, %)	32 (36.0)
Management not per GOLD (n, %)	57 (64.0)

Table 1. Demographic and Clinical Characteristics

Variable

Frequency (n = 158)

SD: standard deviation; COPD: chronic obstructive pulmonary disease; GOLD: Global Initiative for Obstructive Lung Disease.

Age (years, mean (SD))

71.58 (12.9)

Body mass index (kg/m², mean (SD))

27.61 (6.67)

Gender

Male, n (%)

70 (44.3)

Female, n (%)

88 (55.7)

Race

White, n (%)

122 (77.2)

Black, n (%)

21 (13.3)

Asian, n (%)

8 (5.1)

Hispanic, n (%)

7 (4.4)

Social

Smoking (n, %)

152 (96.2)

Diagnosis

COPD (n, %)

150 (94.9)

Emphysema (n, %)

103 (65.2)

Pulmonary follow-up (n, %)

88 (55.7)

Spirometric diagnosis

COPD (n, %)

89 (56.3)

Pulmonary follow-up (n, %)

69 (78.4)

No pulmonary follow-up (n, %)

20 (21.6)

GOLD criteria calculated (n, %)

89 (56.3)

Management per GOLD (n, %)

32 (36.0)

Management not per GOLD (n, %)

57 (64.0)

**Table 2.** Management of COPD
Variable	All frequency (n = 158)	GOLD frequency (n = 32)	No GOLD frequency (n = 57)	P value (GOLD vs. No GOLD)
SABA: short acting beta agonist; LABA: long acting beta agonist; SAMA: short acting antimuscarinic agent; LAMA: long acting antimuscarinic agent; ICS: inhaled corticosteroid.
SABA (n, %)	143 (90.5)	28 (87.5)	55 (96.5)	0.183
LABA (n, %)	89 (56.3)	15 (46.9)	40 (70.2)	< 0.05
SAMA (n, %)	12 (7.6)	4 (12.5)	3 (5.3)	0.246
LAMA (n, %)	65 (41.1)	16 (50.0)	28 (49.1)	0.937
ICS (n, %)	86 (54.4)	8 (25.0)	42 (73.7)	< 0.001
Roflumilast (n, %)	1 (0.6)	0 (0)	1 (1.8)	1.000
Home oxygen therapy (n, %)	38 (24.1)	8 (25.0)	19 (33.3)	0.412
Pulmonary rehabilitation (n, %)	18 (11.4)	9 (28.1)	7 (12.3)	0.062

Table 2. Management of COPD

Variable

All frequency (n = 158)

GOLD frequency (n = 32)

No GOLD frequency (n = 57)

P value (GOLD vs. No GOLD)

SABA: short acting beta agonist; LABA: long acting beta agonist; SAMA: short acting antimuscarinic agent; LAMA: long acting antimuscarinic agent; ICS: inhaled corticosteroid.

SABA (n, %)

143 (90.5)

28 (87.5)

55 (96.5)

0.183

LABA (n, %)

89 (56.3)

15 (46.9)

40 (70.2)

< 0.05

SAMA (n, %)

12 (7.6)

4 (12.5)

3 (5.3)

0.246

LAMA (n, %)

65 (41.1)

16 (50.0)

28 (49.1)

0.937

ICS (n, %)

86 (54.4)

8 (25.0)

42 (73.7)

< 0.001

Roflumilast (n, %)

1 (0.6)

0 (0)

1 (1.8)

1.000

Home oxygen therapy (n, %)

38 (24.1)

8 (25.0)

19 (33.3)

0.412

Pulmonary rehabilitation (n, %)

18 (11.4)

9 (28.1)

7 (12.3)

0.062

**Table 3.** Patient Outcomes
Variable	All frequency (n = 158)	GOLD frequency (n = 32)	No GOLD frequency (n = 57)	P value (GOLD vs. No GOLD)
Oral corticosteroid	77 (48.7)	14 (43.8)	37 (64.9)	0.053
Oral antibiotic	73 (46.2)	16 (50.0)	32 (56.1)	0.577
Increase in home O₂	16 (10.1)	6 (18.8)	7 (12.3)	0.407
Mortality	15 (9.5)	4 (12.5)	7 (12.3)	1.000

Table 3. Patient Outcomes

Variable

All frequency (n = 158)

GOLD frequency (n = 32)

No GOLD frequency (n = 57)

P value (GOLD vs. No GOLD)

Oral corticosteroid

77 (48.7)

14 (43.8)

37 (64.9)

0.053

Oral antibiotic

73 (46.2)

16 (50.0)

32 (56.1)

0.577

Increase in home O₂

16 (10.1)

6 (18.8)

7 (12.3)

0.407

Mortality

15 (9.5)

4 (12.5)

7 (12.3)

1.000