Detection of the adherence of the treatments to "combined chronic obstructive pulmonary disease assessment system" of patients presenting with chronic obstructive pulmonary disease to primary care clinics in izmir province

Objective COPD is a common, preventable and curable disease. The prevalence of COPD in individuals over the age of 40 in Turkey were found to be 19%. Global Initiative for Chronic Obstructive Lung Disease (GOLD); is an international organization established to determine the approaches to the diagnosis, evaluation and treatment of COPD all over the World. Since 2011, GOLD has proposed "Combined Assessment System" which takes into account symptoms, quality of life, and frequency of exacerbations. Combined Assessment System aims to determine disease severity, future risks (exacerbations, hospitalization, death). Treatment according to guidelines is particularly important for disease control and improvement in spirometric values, reduction in treatment costs, reduction in mortality may be observed. There are serious problems with adherence to guidelines in many countries and Turkey, and 45-62% of patients receive inappropriate treatment according to the GOLD groups. The aim of this study is to detection of the adherence of the treatments to 'Combined COPD Assessment System' of patients presenting with COPD to the selected primary care clinic (PCC) in İzmir Province. Methods In our cross-sectional analytical study, all individuals with COPD diagnosed at the age of 18 and over were enrolled in PCC in the central districts of Izmir Province. It was aimed to reach 400 patients in total. Sociodemographic data form, mMRC dyspnea score and CAT COPD assessment test were used in the study. A questionnaire was applied to the participants during their application to the PCC or by telephone. Results 34% of the patients were female and 65.4% were male. The mean age was 60.07 ± 12.81 and 84.6% of the participants were married. The majority (47%) are primary school graduates and 38.5% are non-working / retired groups. 56.6% had additional chronic diseases and 52.2% were using additional medication. 28% of the participants were still smoking and 42.9% were ex-smokers. The mean package / year is 41.25 ± 25.54. The mean year of diagnosis was 8.16 ± 7.64, and the mean year of symptoms was 9.74 ± 8.15. 86.8% were diagnosed by a pulmonologist and 90.7% of them were treated by a pulmonologist. 65.9% of the participants presenting to pulmonologist for follow-up and 17.6% presenting to PCC. 48.9% presenting to PCC every 3 months. In the last year, 35.2% had exacerbation, 83% had low exacerbation risk and 11.5% had hospitalization. The mean mMRC score of the participants was 1.57 and 55% had a low mMRC score. The mean CAT score was 12.5 and 55% had a low CAT score. 54% of the participants were GOLD Group A, 29% were GOLD Group B, 2% were GOLD Group C, 15% were GOLD Group D. According to GOLD, 30.2% of the participants receive appropriate treatment. 35.2% were under-treated or not treated, and 34.6% were over-treated. Conclusion The adherence of the treatments received by COPD patients to Combined COPD Assessment System is low. Half of the patients who do not receive appropriate treatment receive inadequate treatment and the other half receive more treatment than necessary.