Suboptimal medical therapy in COPD - Exploring the causes and consequences

Effective outpatient management of COPD requires prescription of and adhere nce to appropriate therapies. Although practice guidelines for outpatient m anagement of COPD are widely available, evidence suggests that these guidel ines are not being implemented widely in clinical practice, Furthermore, se veral studies have shown that patient compliance with recommended therapy i s poor. This paper discusses several reasons why implementation of practice guidelines and adherence with prescribed therapies may be poor. Potential clinical and economic consequences of suboptimal management are reviewed. A lthough the evidence suggests that improved compliance with guideline-recom mended practice will improve symptoms and disease-specific quality of life, further work needs to he clone to establish the cost-effectiveness of chro nic therapies for COPD relative to other chronic conditions. Without such d ata, managed care organizations will be reluctant to allocate scarce resour ces toward expensive guideline implementation programs for individuals with this condition.