Adoption of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in clinical practice appears to be suboptimal with considerable variability in the implementation of different aspects of the guidelines, according to a review published in Current Opinion in Pulmonary Medicine.
Despite the documented benefits of following GOLD guidelines, adherence has been suboptimal over the years. Therefore, researchers conducted a review of the literature to address the multitude of reasons for the lack of adherence to the GOLD guidelines in clinical practice. The primary and recurrent themes in the literature appear to be both delayed and missed diagnoses of COPD. The reasons for this include a lack of awareness about current COPD guidelines and lack of availability, as well as the use of office spirometry and improper symptom assessment.
Additional issues included improper selection of pharmacotherapy options, misdiagnosis/mislabeling of COPD phenotypes, and the lack of smoking cessation counseling and enrollment in pulmonary rehabilitation. The researchers found that potential solutions to increase adherence to the current GOLD guidelines included adoption of clinical decision support systems via electronic medical records, self-care models, reimbursement-driven care models, and careful phenotyping of patients with COPD.
The investigators concluded that although there are several barriers to adopting the GOLD guidelines into standard COPD care, “[t]hese barriers are all amenable to systematic solutions.”
Ahmad H, Albitar H, Iyer VN. Adherence to Global Initiative for Chronic Obstructive Lung Disease guidelines in the real world: current understanding, barriers, and solutions. Curr Opin Pulm Med. 2020;26:149-154.