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P252 Gold Category And Optimal Management : A Canadian Perspective
  1. K Safka,
  2. L McIvor,
  3. A McIvor
  1. McMaster University, Hamilton, Ontario, Canada

Abstract

Hypothesis Current Canadian guidelines and GOLD strategy for COPD management provide a treatment algorithm based on current symptoms and exacerbation history. We wished to assess COPD patient current objective, subjective symptoms, quality of life and exacerbation history of a random sample in primary care and office based chest medicine clinics. A convenience sample of 500 was selected.

Results We report the characteristics of the first 250 COPD patients from our ongoing 500 patient survey.

Basic demographics 55% Male, 45% Female. Mean age patients 68 ± 12 yrs, all patients were previous smokers with 56 ± 10 pkt/yrs smoking history. 34% remain current smokers.

Mean FEV1 48% ± 10%, Mean FEV1/FVC ratio 49% ± 10. Median mMRC dyspnea score 2. Mean CAT score 18 ± 10 (Range 0–38).

GOLD Stage Classification 13% GOLD Stage A, 67% GOLD Stage B, 1% GOLD Stage C and 19% GOLD Stage D.

Current treatment LAMA (long-acting muscarinic antagonist) was prescribed to over 90% of all patients in groups B, C and D whereas monotherapy with LABA (long acting beta-agonist) or dual bronchodilation with LABA/LAMA therapy was prescribed to less than 5%.

There was significant overtreatment with ICS/LABA in all categories with high dose ICS (inhaled corticosteroid) being preferred.

20% of patients in GOLD Stage A where receiving Triple therapy (LAMA + ICS/LABA) and a further 20% where receiving monotherapy with ICS/LABA, yet had no history of exacerbations.

30% of patients in GOLD Stage B where receiving Triple therapy (LAMA + ICS/LABA) yet had no history of exacerbations.

Conclusion Current Canadian Guidelines and the GOLD strategy focus on symptom relief and striving to prevent exacerbations with step-wise prescription of short and long-acting bronchodilators with individual or combinations of LAMA, LABA, LAMA/LABA or ICS/LABA inhalers. Patients in GOLD Group C are rare. Current prescription choices in our survey does not reflect current evidence or guidelines. We report a heavy reliance on ICS/LABA along with over prescription of triple therapy at all stages of disease.

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