Evaluation of changes in guidelines for medication management of stable chronic obstructive pulmonary disease

Authors

  • Fang-Ju Lin BPharm MSc,

    Doctoral Candidate
    1. Department of Pharmacy Administration, University of Illinois at Chicago, Chicago, IL, USA
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  • Todd A. Lee PharmD PhD,

    Assistant Director, Associate Professor
    1. Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
    2. Departments of Pharmacy Practice and Pharmacy Administration, University of Illinois at Chicago, Chicago, IL, USA
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  • Pei Shieen Wong BPharm,

    PharmD Student
    1. College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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  • A. Simon Pickard PhD

    Corresponding author
    1. Departments of Pharmacy Practice and Pharmacy Administration, University of Illinois at Chicago, Chicago, IL, USA
    • Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
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  • This study was presented as a poster at the American Thoracic Society International Conference, 18–23 May 2012, San Francisco, CA, USA. The authors declare that there is no conflict of interest in the publication of this study.

Correspondence

Dr A. Simon Pickard

Departments of Pharmacy Practice and Pharmacy Administration, and Center for Pharmacoeconomic Research

College of Pharmacy

University of Illinois at Chicago

833 South Wood Street

Room 164, M/C 886

Chicago, IL 60612

USA

E-mail: pickard1@uic.edu

Abstract

Rationale, aims and objectives

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are well-known international clinical practice guidelines for chronic obstructive pulmonary disease (COPD). The objective of this study was to examine how treatment recommendations and the quality of supporting evidence for pharmacologic management of stable COPD have evolved since the initial guidance issued in 2001.

Methods

Recommendations in the 2001 and 2011 GOLD guidelines, along with the evidence grades (i.e. A, B, C, D), were identified and abstracted. We determined the distribution and evolution of recommendations across levels of evidence and treatment categories over time.

Results

There were 35 and 54 recommendations identified in the 2001 and 2011 guidelines, respectively. Twenty-six recommendations were common to the 2001 and 2011 guidelines, with eight having the same evidence grade in both versions and three having a grade change (one upgraded and two downgraded). Twenty-eight new recommendations were added in 2011. Bronchodilators, glucocorticosteroids, and phosphodiesterase-4 inhibitors are the classes of pharmacologic treatment with the most prominent changes regarding emerging evidence and the number of recommendations. Approximately 45% of the graded recommendations were supported by well-designed randomized controlled trials, i.e. grade A.

Conclusions

The GOLD guideline recommendations have changed considerably over the past 11 years, which reflects a dynamic evidence base and perhaps a change in the way guideline developers view the evidence to inform recommendations. Given the large number of recommendations with lower grade levels, there continues to be substantial opportunity to inform gaps in the evidence base with high-quality studies.

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