Many COPD Treatments Overused, Ineffective

A study in the International Journal of Chronic Obstructive Pulmonary Disease identified a number of practices used to treat chronic obstructive pulmonary disease (COPD) that are over-utilized and ineffective.

The researchers sought to decrease the prevalence of low-value treatment practices among COPD patients because use of these services continues despite guidelines.

“Clinical guidelines advise health care professionals on appropriate procedures for diagnosis, treatment, and follow-up in step with evolving knowledge of [COPD],” Felipe Villar-Álvarez, of the “Do not do in COPD” Working Group of the Madrid Society of Pulmonology and Thoracic Surgery, and colleagues wrote. “Despite this information, guides are not always applied cor­rectly and a number of inappropriate practices persist with a certain degree of frequency.”

A panel of six pulmonologists, two general practitioners, a nurse, and a physiotherapist developed a set of “do not use” guidelines. The researchers first drafted a list of commonly over-utilized services and self-care practices among patients with mild to severe COPD. They then wrote descriptive recommendations against the use of these practices.

They developed recommendations for six procedures for patients with stable COPD. These included recommendations against the use of inhaled corticosteroids as routine treatment for patients with very low COPD scores, any treatment before confirmed diagnostics with spirometry, and changing therapy without confirming proper adherence.

They also developed recommendations for six practices among patients with severe COPD, including recommendations against the use of antibiotics ad nebulizing therapy as broad treatments, and use of spirometry in patients with known COPD.

The researchers also advised against use of four commonly wasteful self-care practices among COPD patients including taking unprescribed treatments and discontinuing walking exercise due to labored breathing.

“We can conclude from this study that “do not do” recom­mendations in COPD are likely to improve management of patients with the disease by reducing the rate with which improper or scarcely cost-effective practices are used in clini­cal care and patient self-care,” Dr Villar-Álvarez and colleagues concluded. “Furthermore, the use of these recommendations will lower care risks, improve physician–patient communication, and empower patients to undertake in-home self-care.”

—David Costill

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