الفهرس 
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Abstract
Background:
Chronic obstructive pulmonary disease (COPD) is currently defined as “a preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases” (GOLD, 2013).
The general view of this disease is that it will become one of the major health challenges of the next few decades. Prevalence surveys suggest that up to almost a quarter of adults aged 40 years and older have mild airflow obstruction (Buist et al., 2007; Mannino and Buist, 2007; Menezes et al., 2005).
Mortality owing to cardiac diseases and stroke decreased over the period 1970–2002, but that of COPD doubled over the same period (Jemal et al., 2005).
The US National Heart, Lung, and Blood Institute and the World Health Organization established the Global Initiative for chronic Obstructive Lung Disease (GOLD) to prepare a standard guideline for the management of COPD (GOLD, 2001).
Despite the existence of guidelines for the diagnosis and management of the condition for more than 10 years, there is a wide variation in physicians’ management of the condition and this may be ascribed to non-adherence to the guidelines. Adherence to COPD guidelines in clinical practice in most countries is not satisfactory (Yawn and Wollan, 2008; Harvey et al., 2005; Chavez and Shokar, 2009; Bourbeau et al., 2008).
Aim of the work:
The aim of this work is to assess prescription pattern and clinical practice attitudes towards Egyptian COPD patients managed by chest physicians and internal medicine physicians in Abbassia Chest Hospital and Ain Shams University Hospitals during period from February 2013 to January 2014.
Subjects and methods:
This study included 104 COPD patients and 116 doctors.
All participated doctors were subjected to a questionnaire to evaluate their clinical practice according to GOLD 2013 recommendations for COPD patient management.
COPD patients included in the present study were either selected from the outpatient chest clinics, inpatient departments or intensive care unit from both selected hospitals.
Diagnosis of COPD was done according to Global Initiative for chronic Obstructive Lung Disease guideline (GOLD), 2013.
All patients were subjected to:
1- Full medical history taking and Physical examination.
2- Chest x-ray.
3- Post bronchodilator spirometric study according to (GOLD), 2013. In case of patients who can’t perform spirometry they were included only if there were previous spirometric documents available.
4-Questionnaire to detect epidemiology, demographics, clinical characteristic of the patients and available prescription pattern.
5-COPD assessment test (CAT).
Results:
One hundred and four patients fulfilled the diagnostic criteria of COPD.
The mean age of patients was 60.8750 ± 9.08395 and only 2.9% of studied patients were females.
The majority of COPD patients were of low social class indicated by low educational level.
Nearly all COPD patients were either current or ex smokers.
Most of patients belonged to D group according to GOLD 2013 patient classification and had severe or very severe airway obstruction.
Only 34.6% of patients had COPD diagnosis based on spirometry.
Most of patients were on oral theophylline, short acting B2 agonist whether alone or in combination with inhaled corticosteroids.
There was no rule for patient education and pulmonary rehabilitation in the management of studied patients.
Hypertension, diabetes mellitus and ischemic heart disease were the most common comorbidities encountered with COPD patients.
Most of the doctors participated in this study were males65.5% with mean age 33.94 ±9.561.
Sixty doctors worked at Abbassia Chest Hospital while fifty six worked at Ain Shams University Hospitals.
Most of doctors had less than 4 years of practical experience.
Doctors were either chest residents (33%), chest physicians with master degree (35%), chest physicians with MD (13%) and internal medicine doctors (19%).
Only 49 physicians performed spirometry to patients.
Common causes for not performing spirometry to COPD patients were non availability and depending on clinical diagnosis only.
Most of physicians prescribed antibiotics and systemic steroids to their patients in exacerbations.
Macrolides, third generation cephalosporins and respiratory quinolones were the most antibiotics prescribed by physicians in COPD exacerbations.
Only 37 physicians used non invasive ventilation in hypercapnic respiratory failure.
Only 26 physicians were following GOLD 2013 guidelines in daily prescription practice.