Abstract
BACKGROUND: General Practice/Family Medicine (GP/FM) has an important role in the management of chronic obstructive pulmonary disease (COPD), which is receiving an increasing interest in primary care. AIMS: A literature review was made with the aim of comparing the clinical practice guidelines for COPD with a relevance to GP/FM and exploring any potential sources of discrepancy among their recommendations. METHODS: We searched the computerized database MEDLINE (PubMed) (from 1990 to 2001) using a combination of key words. Six leading journals (New England Journal of Medicine, Lancet, JAMA, BMJ, Thorax and Chest) were thoroughly searched manually. All clinical practice guidelines for COPD and research papers in relation to their dissemination or their implementation in General Practice, written in English, French or German were included in our review. Each paper was independently reviewed twice. The reviewers examined the guidelines and research papers for specific components regarding the management of COPD in GP. RESULTS: 24 articles fulfilled our review criteria. We found significant disagreement among clinical practice guidelines regarding the assessment of COPD. Furthermore, evidence based knowledge in GP, as this was reflected from the selected research papers, often contrasted with the recommendations. Key issues from these discrepancies are presented and discussed. CONCLUSIONS: Although interest in the management of COPD in primary care is on the increase, evidence based clinical practice guidelines for COPD in General Practice is still a neglected subject.