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de Miguel-Díez J, Figueira-Gonçalves JM, Trillo-Calvo E, Cimas-Hernando JE, Villanueva-Pérez M, Plaza-Zamora FJ, Sanz-Almazán M. Referral Criteria for Chronic Obstructive Pulmonary Disease: A Proposal of Continuity of Care. Arch Bronconeumol 2024; 60:7-9. [PMID: 37827952 DOI: 10.1016/j.arbres.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Javier de Miguel-Díez
- Pneumology Service of Hospital General Universitario Gregorio Marañón, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Marco Figueira-Gonçalves
- Respiratory Department, Research Unit, Hospital Universitario Nuestra Señora de Candelaria, La Laguna, Spain; Canary Tropical Disease and Public Health Institute, Universidad de La Laguna, San Cristóbal de la Laguna, Spain.
| | - Eva Trillo-Calvo
- Aragonese Health Service, Primary Care, Centro de Salud Campo de Belchite, Zaragoza, Spain
| | | | - Marta Villanueva-Pérez
- EAP Ribes-Olivella (SAP Alt Penedés Garraf), Institut Català de la Salut, Tarragona, Spain
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Savic-Pesic D, Chamorro N, Lopez-Rodriguez V, Daniel-Diez J, Torres Creixenti A, El Mesnaoui MI, Benavides Navas VK, Castellanos Cotte JD, Abellan Cano I, Da Costa Azevedo FA, Trenza Peñas M, Voelcker-Sala I, Villalobos F, Satue-Gracia EM, Martin-Lujan F. Validity of the Espiro Mobile Application in the Interpretation of Spirometric Patterns: An App Accuracy Study. Diagnostics (Basel) 2023; 14:29. [PMID: 38201338 PMCID: PMC10795716 DOI: 10.3390/diagnostics14010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the interpretation of spirometry results; however, as yet none are validated. We evaluated the interpretation accuracy of the Espiro app using pulmonologist interpretations as the gold standard. This is an observational descriptive study in which 118 spirometry results were interpreted by the Espiro app, two pulmonologists, two primary care physicians, and two residents of a primary care training program. We determined the interpretation accuracy of the Espiro app and the concordance of the pattern and severity interpretation between the Espiro app and each of the observers using Cohen's kappa coefficient (k). We obtained a sensitivity and specificity for the Espiro app of 97.5% (95% confidence interval (CI): 86.8-99.9%) and 94.9% (95%CI: 87.4-98.6%) with pulmonologist 1 and 100% (95%CI: 91.6-100%) and 98.7% (95%CI: 92.9-99.9%) with pulmonologist 2. The concordance for the pattern interpretation was greater than k 0.907, representing almost perfect agreement. The concordance of the severity interpretation was greater than k 0.807, representing substantial to almost perfect agreement. We concluded that the Espiro app is a valid tool for spirometry interpretation.
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Affiliation(s)
- Darinka Savic-Pesic
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Carrer de Sant Llorenç, 21, 43201 Reus, Spain
| | - Nuria Chamorro
- Pneumology Service, Hospital Universitari de Tarragona Joan XXII, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Vanesa Lopez-Rodriguez
- Pneumology Service, Hospital Universitari de Tarragona Joan XXII, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Jordi Daniel-Diez
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Anna Torres Creixenti
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Mohamed Issam El Mesnaoui
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Viviana Katherine Benavides Navas
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Jose David Castellanos Cotte
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Iván Abellan Cano
- Primary Care Unit, Sanitat Conselleria, Generalitat Valenciana, Dpto 18, Carretera de Sax s/n, 03600 Elda, Spain
| | | | - María Trenza Peñas
- Centro de Salud Aguilas Sur, Primary Care Unit, Servicio Murciano de Salud, Calle Rey Carlos III, s/n, 30880 Aguilas, Spain
| | - Iñaki Voelcker-Sala
- College of Medicine and Public Health, Flinders University, Flinders Drive, Bedford Park, SA 5042, Australia
| | - Felipe Villalobos
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
| | - Eva-María Satue-Gracia
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- Primary Care Research Support Unit Reus-Tarragona, Institut Català de la Salut, Camí de Riudoms, 53–55, 43202 Reus, Spain
| | - Francisco Martin-Lujan
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Carrer de Sant Llorenç, 21, 43201 Reus, Spain
- Primary Care Research Support Unit Reus-Tarragona, Institut Català de la Salut, Camí de Riudoms, 53–55, 43202 Reus, Spain
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Wang Y, Li Y, Chen W, Zhang C, Liang L, Huang R, Liang J, Tu D, Gao Y, Zheng J, Zhong N. Deep learning for spirometry quality assurance with spirometric indices and curves. Respir Res 2022; 23:98. [PMID: 35448995 PMCID: PMC9028127 DOI: 10.1186/s12931-022-02014-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Spirometry quality assurance is a challenging task across levels of healthcare tiers, especially in primary care. Deep learning may serve as a support tool for enhancing spirometry quality. We aimed to develop a high accuracy and sensitive deep learning-based model aiming at assisting high-quality spirometry assurance. Methods Spirometry PDF files retrieved from one hospital between October 2017 and October 2020 were labeled according to ATS/ERS 2019 criteria and divided into training and internal test sets. Additional files from three hospitals were used for external testing. A deep learning-based model was constructed and assessed to determine acceptability, usability, and quality rating for FEV1 and FVC. System warning messages and patient instructions were also generated for general practitioners (GPs). Results A total of 16,502 files were labeled. Of these, 4592 curves were assigned to the internal test set, the remaining constituted the training set. In the internal test set, the model generated 95.1%, 92.4%, and 94.3% accuracy for FEV1 acceptability, usability, and rating. The accuracy for FVC acceptability, usability, and rating were 93.6%, 94.3%, and 92.2%. With the assistance of the model, the performance of GPs in terms of monthly percentages of good quality (A, B, or C grades) tests for FEV1 and FVC was higher by ~ 21% and ~ 36%, respectively. Conclusion The proposed model assisted GPs in spirometry quality assurance, resulting in enhancing the performance of GPs in quality control of spirometry. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02014-9.
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Affiliation(s)
- Yimin Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Yicong Li
- Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, 518055, China.,Huawei Cloud BU EI Innovation Laboratory, Huawei Technologies, Shenzhen, 518129, China
| | - Wenya Chen
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Changzheng Zhang
- Huawei Cloud BU EI Innovation Laboratory, Huawei Technologies, Shenzhen, 518129, China
| | - Lijuan Liang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Ruibo Huang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Jianling Liang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Dandan Tu
- Huawei Cloud BU EI Innovation Laboratory, Huawei Technologies, Shenzhen, 518129, China
| | - Yi Gao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China.
| | - Jinping Zheng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China.
| | - Nanshan Zhong
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Yanjiang Road 151, Guangzhou, 510120, Guangdong, People's Republic of China.
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Miravitlles M, Solé A, Aguilar H, Ampudia A, Costa-Samarra J, Mallén-Alberdi M, Nieves D. Economic Impact of Low Adherence to COPD Management Guidelines in Spain. Int J Chron Obstruct Pulmon Dis 2021; 16:3131-3143. [PMID: 34848952 PMCID: PMC8611727 DOI: 10.2147/copd.s322793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the non-adherence level of Spanish clinical practice to guideline recommendations for the treatment of chronic obstructive pulmonary disease (COPD) and to estimate the potential impact on pharmaceutical expenditure resulting from transitioning current treatment patterns according to guidelines. METHODS A model was developed to compare current prescribing patterns with two alternative scenarios: the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) recommendations, and the second with the Spanish Guidelines for COPD (GesEPOC 2017). Current treatment practice was obtained from publications that describe treatment patterns by pulmonology departments in Spain. The economic impact between patterns was calculated from the perspective of the Spanish National Health System (NHS), considering the annual pharmacological costs of COPD inhaled maintenance therapy. Two additional analyses were performed: one that included current prescribing patterns of patients managed by pulmonology and primary care centers in Spain (published aggregated data); and another that only considered the appropriate use of inhaled corticosteroids (ICS) treatment according to guidelines. RESULTS It was estimated that 54% and 38% of patients were not treated in line with GOLD and GesEPOC recommendations, respectively, mainly due to a broader use of ICS-based therapies. Adapting treatment to recommendations could provide a potential annual cost-saving of €17,792,022 (according to GOLD) and €5,881,785 (according to GesEPOC). In scenario analysis 1, a 26% of non-adherence to GesEPOC guideline was observed with a potential annual pharmacological cost-saving of €2,707,554. In scenario analysis 2, considering only inappropriate use of ICS treatment, an annual cost-saving of €17,863,750 (according to GOLD) and €9,904,409 (according to GesEPOC) was calculated. CONCLUSION More than a third of treatments for COPD patients in Spain are not prescribed in accordance with guideline recommendations. The adaptation of clinical practice to guideline recommendations could provide important cost-savings for the Spanish NHS.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER for Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alexandra Solé
- Market Access Department of Boehringer Ingelheim SA, Barcelona, Spain
| | - Helena Aguilar
- Medical Department of Boehringer Ingelheim SA, Barcelona, Spain
| | - Ana Ampudia
- Market Access Department of Boehringer Ingelheim SA, Barcelona, Spain
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Monteagudo M, Barrecheguren M, Solntseva I, Dhalwani N, Booth A, Nuñez A, Lambrelli D, Miravitlles M. Clinical characteristics and factors associated with triple therapy use in newly diagnosed patients with COPD. NPJ Prim Care Respir Med 2021; 31:16. [PMID: 33753747 PMCID: PMC7985144 DOI: 10.1038/s41533-021-00227-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/03/2021] [Indexed: 12/18/2022] Open
Abstract
There is limited information about the initiation of triple therapy (TT) in patients with chronic obstructive pulmonary disease (COPD) in primary care. This was an observational, population-based study in patients identified from a primary care electronic medical records database in Catalonia from 2011 to 2015 aimed to identify the use of TT in patients with newly diagnosed COPD. A total of 69,668 newly diagnosed patients were identified of whom 11,524 (16.5%) initiated TT, of whom 8626 initiated TT at or immediately after COPD diagnosis. Among them, 72.3% were GOLD A/B, 14.6% were frequent exacerbators, and 7.1% had asthma-COPD overlap (ACO). Variables associated with TT initiation were: male sex, older age, previous exacerbations, ACO, a previous treatment regimen containing an inhaled corticosteroid, previous pneumonia, and history of lung cancer. A significant number of COPD patients in Primary Care initiated TT shortly after or even before an established COPD diagnosis.
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Affiliation(s)
- Mònica Monteagudo
- Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Iryna Solntseva
- Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | | | - Alexa Nuñez
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Marc Miravitlles
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care. NPJ Prim Care Respir Med 2018; 28:36. [PMID: 30266978 PMCID: PMC6162319 DOI: 10.1038/s41533-018-0102-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 11/08/2022] Open
Abstract
This epidemiological study aimed to describe and compare the characteristics and outcomes of COPD patients starting treatment with a long-acting anti-muscarinic (LAMA) or a combination of a long-acting beta-2 agonist (LABA)/LAMA in primary care in Catalonia (Spain) over a one-year period. Data were obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database containing information of 5.8 million inhabitants (80% of the population of Catalonia). Patients initiating treatment with a LAMA or LABA/LAMA in 2015 were identified, and information about demographic and clinical characteristics was collected. Then, patients were matched 1:1 for age, sex, FEV1%, history of exacerbations, history of asthma and duration of treatment, and the outcomes between the two groups were compared. During 2015, 5729 individuals with COPD started treatment with a LAMA (69.8%) or LAMA/LABA (30.2%). There were no remarkable differences between groups except for a lower FEV1 and more previous hospital admissions in individuals on LABA/LAMA. The number of tests and referrals was low and decreased in both groups during follow-up. For the same severity status, the evolution was similar with a reduction in exacerbations in both groups. Treatment was changed during follow-up in up to 34.2% of patients in the LABA/LAMA and 26.3% in the LAMA group, but adherence was equally good for both. Our results suggest that initial therapy with LAMA in monotherapy may be adequate in a significant group of mild to moderate patients with COPD and a low risk of exacerbations managed in primary care. A single rather than combined long-acting inhaler therapy may be adequate for most patients when treating mild to moderate chronic lung disease. Marc Miravitlles at the Hospital Universitari Vall d’Hebron, Barcelona, Spain, and co-workers have shown that, in the initial stages of chronic obstructive pulmonary disease (COPD), treatment with an inhaled drug called a long-acting anti-muscarinic agent (LAMA) is as effective as an alternative inhaler that combines LAMA with another drug (LABA). The researchers identified 5729 COPD patients from Catalonia starting on inhaled treatment in 2015 and followed up on their progress after 1 year. Patients starting on LAMA monotherapy were matched closely in terms of demographics and previous medical history to those starting on LAMA/LABA treatment. The team found no remarkable differences in clinical characteristics between the groups over the year.
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Hidalgo Sierra V, Hernández Mezquita MÁ, Palomo Cobos L, García Sánchez M, Diego Castellanos R, Jodra Sánchez S, Cordovilla Pérez R, Barrueco Ferrero M. Usefulness of the Piko-6 Portable Device for Early COPD Detection in Primary Care. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Usefulness of The Piko-6 Portable Device for Early COPD Detection in Primary Care. Arch Bronconeumol 2018; 54:460-466. [PMID: 29880313 DOI: 10.1016/j.arbres.2018.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/01/2018] [Accepted: 04/09/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV6 and FEV1/FEV6, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS. METHODS FS and Piko-6 determinations were made in 155 patients suspected of having COPD. The correlations, ROC curves, and Youden's index of both methods were compared, taking FS as the gold standard. RESULTS FEV1, FVC and FEV6 correlation coefficients and FEV1/FVC and FEV1/FEV6 ratios were 0.87 (CI 0.836-0.909), 0.729 (CI 064-0.795) and 0.947 (95% CI 0.928-0.961), respectively. The ROC curve for FEV1 determined by Piko-6 achieved an area under the curve of 0.86 (95% CI: 0.78-0.92). Youden's index with a cut-off point of 0.70 for FEV1/FEV6 was 0.97. CONCLUSIONS Piko-6 may be useful for COPD screening in PC. Measurements obtained with this device correlate well with those determined by FS, particularly the FEV1/FEV6 ratio. This, combined with its low cost and ease of use, may contribute to reducing COPD underdiagnosis, although its exact role in the diagnostic process remains to be determined.
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Ferrara R, Ientile V, Piccinni C, Pasqua A, Pecchioli S, Fontana A, Alecci U, Scoglio R, Magliozzo F, Torrisi SE, Vancheri C, Vitulo P, Fantaci G, Ferrajolo C, Cazzola M, Cricelli C, Caputi AP, Trifirò G. Improvement in the management of chronic obstructive pulmonary disease following a clinical educational program: results from a prospective cohort study in the Sicilian general practice setting. NPJ Prim Care Respir Med 2018; 28:10. [PMID: 29572448 PMCID: PMC5865126 DOI: 10.1038/s41533-018-0077-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 11/09/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder of the lungs associated with progressive disability. Although general practitioners (GPs) should play an important role in the COPD management, critical issues have been documented in the primary care setting. The aim of this study was to evaluate the effectiveness of an educational program for the improvement of the COPD management in a Sicilian general practice setting. The effectiveness of the program, was evaluated by comparing 15 quality-of-care indicators developed from data extracted by 33 GPs, at baseline vs. 12 and 24 months, and compared with data from a national primary care database (HSD). Moreover, data on COPD-related and all-cause hospitalizations over time of COPD patients, was measured. Overall, 1,465 patients (3.2%) had a registered diagnosis of COPD at baseline vs. 1,395 (3.0%) and 1,388 (3.0%) over time (vs. 3.0% in HSD). COPD patients with one spirometry registered increased from 59.7% at baseline to 73.0% after 2 years (vs. 64.8% in HSD). Instead, some quality of care indicators where not modified such as proportion of COPD patients treated with ICS in monotherapy that was almost stable during the study period: 9.6% (baseline) vs. 9.9% (after 2 years), vs. 7.7% in HSD. COPD-related and all-cause hospitalizations of patients affected by COPD decreased during the two observation years (from 6.9% vs. 4.0%; from 23.0% vs. 18.9%, respectively). Our study showed that educational program involving specialists, clinical pharmacologists and GPs based on training events and clinical audit may contribute to partly improve both diagnostic and therapeutic management of COPD in primary care setting, despite this effect may vary across GPs and indicators of COPD quality of care.
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Affiliation(s)
- Rosarita Ferrara
- Unit of Clinical Pharmacology, Academic Hospital G. Martino, Messina, Italy
| | - Valentina Ientile
- Unit of Clinical Pharmacology, Academic Hospital G. Martino, Messina, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Serena Pecchioli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Umberto Alecci
- Italian Society of General Practice (SIMG), Catania, Italy
| | | | | | - Sebastiano Emanuele Torrisi
- Regional Referral Center for Rare Lung Diseases, University - Hospital "G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Regional Referral Center for Rare Lung Diseases, University - Hospital "G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Giovanna Fantaci
- Epidemiologic Observatory - Sicilian Regional Department of Health, Palermo, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Gianluca Trifirò
- Unit of Clinical Pharmacology, Academic Hospital G. Martino, Messina, Italy.
- Department of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.
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Pirina P, Martinetti M, Spada C, Zinellu E, Pes R, Chessa E, Fois AG, Miravitlles M. Prevalence and management of COPD and heart failure comorbidity in the general practitioner setting. Respir Med 2017; 131:1-5. [PMID: 28947013 DOI: 10.1016/j.rmed.2017.07.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND COPD frequently coexists with HF with which shares several risk factors. A greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. This observational, retrospective study provides new data regarding the management of these patients. METHODS from the Health Search Database which collects information generated by the routine activity of general practitioners, we selected 803 patients suffering from COPD or HF alone or combined analyzing similarities and differences regarding risk factors, diagnostic workup and therapeutic approaches. MAIN RESULTS Statistical analyses have evidenced significant differences regarding exposure to cigarette smoke and the prevalence of diabetes and hypertension in the three groups of patients. As regard to the diagnostic workup, it has been found that the 63,9% of COPD patients and the 57,1% of COPD + HF patients performed a spirometry vs the 95,4% of HF patients and the 95,2% of COPD + HF patients that performed an ECG. Regarding the pharmacologic treatment, the 47% of COPD patients was treated with an ICS/LABA association and the 22% with ICS/LABA + LAMA. In the COPD + HF group, 47% of patients were treated with ICS/LABA association, while 32% of these patients were treated with ICS/LABA + LAMA. The pharmacologic treatment most prescribed in HF was β-blockers (68%), diuretics (92.8%), antiplatelet therapy (55.6%) and ACE inhibitors (38.1%). In the COPD + HF group, β-blockers (40.1%), diuretics (89.8%), antiplatelet therapy (57.1%) and ACE inhibitors (44.9%) were prescribed. CONCLUSION this study has evidenced a disparity in performing instrumental diagnosis between COPD and HF groups that persists when both conditions coexist. Moreover, the pharmacological treatment of the two conditions shows a consistent under treatment with bronchodilators in COPD patients and with β-blockers in HF patients.
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Affiliation(s)
- Pietro Pirina
- Department of Respiratory Diseases, Azienda Ospedaliero Universitaria, Sassari, Italy.
| | | | - Claudia Spada
- Department of Respiratory Diseases, Azienda Ospedaliero Universitaria, Sassari, Italy
| | - Elisabetta Zinellu
- Department of Respiratory Diseases, Azienda Ospedaliero Universitaria, Sassari, Italy
| | | | | | | | - Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Proceso de la atención inicial al paciente con EPOC. Estrategias de cribado. Arch Bronconeumol 2017. [DOI: 10.1016/s0300-2896(17)30359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Monteagudo M, Roset M, Rodriguez-Blanco T, Muñoz L, Miravitlles M. Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study. Int J Chron Obstruct Pulmon Dis 2017; 12:1145-1152. [PMID: 28442901 PMCID: PMC5396831 DOI: 10.2147/copd.s131016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia. DESIGN We performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. A descriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts. RESULTS A total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0-8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months. CONCLUSION Patients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy.
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Affiliation(s)
- Mònica Monteagudo
- Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | | | - Teresa Rodriguez-Blanco
- Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Laura Muñoz
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Llordés M, Jaén A, Almagro P, Heredia JL, Morera J, Soriano JB, Miravitlles M. Prevalence, Risk Factors and Diagnostic Accuracy of COPD Among Smokers in Primary Care. COPD 2016; 12:404-12. [PMID: 25474184 DOI: 10.3109/15412555.2014.974736] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence of COPD is high, and most cases remain undiagnosed. In contrast, some patients labeled and treated as COPD do not have spirometric confirmation. Our objective was to determine the prevalence of COPD among smokers aged 45 years or older and investigate the accuracy of diagnosis of COPD in primary care. A population-based, epidemiological study was conducted in a primary care centre among subjects older than 45 years with a history of smoking. The participants underwent a clinical questionnaire and spirometry with bronchodilator test. Additionally, participants with newly diagnosed COPD, defined as postbronchodilator FEV1/FVC<0.7, underwent 4-week treatment with formoterol and budesonide to rule out reversible airflow obstruction. A total of 1,738 individuals (84.4% male) with a mean age of 59.9 years were included. The prevalence of COPD was 24.3% (95%, CI 22.3-26.4), with an overall underdiagnosis of 56.7%. Patients with COPD were older, more frequently male, with a lower body mass index, a longer history of smoking, lower educational level, previous occupational exposure, and more cardiovascular co-morbidity (all p < 0.001). After 4 weeks of treatment, 16% of initially obstructed patients had normal spirometry; in addition, 15.6% of individuals with a diagnosis of COPD did not have airflow obstruction. One out of four smokers 45 years or older presenting in primary care have airflow obstruction, mostly undiagnosed. However, among those with an initial diagnosis of COPD up to 16% will normalise spirometry after 4 weeks of treatment. There is also a significant number of individuals misdiagnosed with COPD.
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Affiliation(s)
- Montserrat Llordés
- a Primary Care Center Terrassa Sud. Hospital Universitari Mutua de Terrassa, University of Barcelona , Barcelona , Spain
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Treatment patterns in COPD patients newly diagnosed in primary care. A population-based study. Respir Med 2015; 111:47-53. [PMID: 26758585 DOI: 10.1016/j.rmed.2015.12.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Treatment for COPD is tailored based on clinical characteristics and severity. However, prescription patterns in COPD patients newly diagnosed in primary care may differ from guideline recommendations. METHOD We performed an epidemiological study with data obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million inhabitants (80% of the population of Catalonia). Patients newly diagnosed with COPD from 2007 to 2012 were identified and information about the initial treatment patterns was collected. The initial treatment was also described by phenotype and severity. RESULTS During the study period 41,492 patients were newly diagnosed with COPD. Patients were classified as non exacerbators (28,552 patients, 69%), asthma-COPD overlap syndrome (ACOS) (2152 patients, 5.2%) and frequent exacerbators (10,888 patients, 27.6%). Among the patients in whom FEV1 was available, 13.9% were GOLD stage 1, 55.2% stage 2, 26% stage 3 and 4.8% stage 4. Globally, the most frequently prescribed treatment patterns were short-acting bronchodilators (SABD) in monotherapy (17.7%), long-acting β-2 agonists (LABA) + inhaled corticosteroids (ICS) (17.3%) and triple therapy (12.2%). The frequency of patients treated with a SABD increased from 15.9% to 19.5% during the study period, while the number of untreated patients decreased from 24.4% to 15.1%. Up to 45.2% of patients were initially treated with ICS, which were frequently prescribed in the ACOS (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non exacerbator patients. Up to 13.6% and 14.8% of GOLD 4 patients received no treatment or only SABD after diagnosis. CONCLUSIONS Initial treatment patterns in newly diagnosed COPD patients often do no comply with guidelines. The use of ICS is excessive but has decreased mainly in non exacerbator patients. Many COPD patients still remain untreated after diagnosis, although this has decreased. Some GOLD 4 patients are still receiving SABD or no treatment at all after diagnosis.
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Márquez-Martín E, Soriano JB, Rubio MC, Lopez-Campos JL. Differences in the use of spirometry between rural and urban primary care centers in Spain. Int J Chron Obstruct Pulmon Dis 2015; 10:1633-9. [PMID: 26316737 PMCID: PMC4544627 DOI: 10.2147/copd.s86074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. METHODS An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. RESULTS Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P<0.01). The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. CONCLUSION This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these areas.
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Affiliation(s)
- Eduardo Márquez-Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain
| | - Myriam Calle Rubio
- Servicio de Neumología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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A clinical study of COPD severity assessment by primary care physicians and their patients compared with spirometry. Am J Med 2015; 128:629-37. [PMID: 25595469 DOI: 10.1016/j.amjmed.2014.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Primary care physicians often do not use spirometry to confirm the diagnosis of chronic obstructive pulmonary disease. This project was designed to see how well physicians' impressions about their patients' chronic obstructive pulmonary disease severity correlate with the severity of airflow obstruction measured by spirometry and to assess whether spirometry results subsequently changed the physicians' opinions about chronic obstructive pulmonary disease severity and treatment. METHODS We performed a multicenter, cross-sectional, observational study conducted in 83 primary care clinics from across the United States. A total of 899 patients with a clinical diagnosis of chronic obstructive pulmonary disease completed a questionnaire and spirometry testing. Physicians completed a questionnaire and case report forms. Concordance among physician ratings, patient ratings, and spirometry results was evaluated. RESULTS Physicians' chronic obstructive pulmonary disease severity ratings before spirometry were accurate for only 30% of patients with evaluable spirometry results, and disease severity in 41% of patients was underestimated. Physicians also underestimated severity compared with patients' self-assessment among 42% of those with evaluable results. After spirometry, physicians changed their opinions on the severity for 30% of patients and recommended treatment changes for 37%. Only 75% of patients performed at least 1 high-quality spirometry test; however, the physicians' opinions and treatment decisions were similar regardless of suboptimal test results. CONCLUSIONS Without performing spirometry, physicians are likely to underestimate their patients' chronic obstructive pulmonary disease severity or inadequately characterize their patients' lung disease. Spirometry changed the physicians' clinical impressions and treatments for approximately one third of these patients; thus, spirometry is a valuable tool for chronic obstructive pulmonary disease management in primary care.
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Blasi F, Cesana G, Conti S, Chiodini V, Aliberti S, Fornari C, Mantovani LG. The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients. PLoS One 2014; 9:e101228. [PMID: 24971791 PMCID: PMC4074190 DOI: 10.1371/journal.pone.0101228] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a common disease with significant health and economic consequences. This study assesses the burden of COPD in the general population, and the influence of exacerbations (E-COPD) on disease progression and costs. METHODS This is a secondary data analysis of healthcare administrative databases of the region of Lombardy, in northern Italy. The study included ≥ 40 year-old patients hospitalized for a severe E-COPD (index event) during 2006. Patients were classified in relation to the number and type of E-COPD experienced in a three-year pre-index period. Subjects were followed up until December 31st, 2009, collecting data on healthcare resource use and vital status. RESULTS 15857 patients were enrolled -9911 males, mean age: 76 years (SD 10). Over a mean follow-up time of 2.4 years (1.36), 81% of patients had at least one E-COPD with an annual rate of 3.2 exacerbations per person-year and an all-cause mortality of 47%. A history of exacerbation influenced the occurrence of new E-COPD and mortality after discharge for an E-COPD. On average, the healthcare system spent 6725€ per year per person (95%CI 6590-6863). Occurrence and type of exacerbations drove the direct healthcare cost. Less than one quarter of patients presented claims for pulmonary function tests. CONCLUSIONS COPD imposes a substantial burden on healthcare systems, mainly attributable to the type and occurrence of E-COPD, or in other words, to the exacerbator phenotypes. A more tailored approach to the management of COPD patients is required.
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Affiliation(s)
- Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Cesana
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Sara Conti
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Virginio Chiodini
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Stefano Aliberti
- Department of Health Sciences, University of Milano – Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy
| | - Carla Fornari
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Lorenzo Giovanni Mantovani
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
- University of Napoli Federico II, Naples, Italy
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Lopez-Campos JL, Bustamante V, Muñoz X, Barreiro E. Moving towards patient-centered medicine for COPD management: multidimensional approaches versus phenotype-based medicine--a critical view. COPD 2014; 11:591-602. [PMID: 24914771 DOI: 10.3109/15412555.2014.898035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
For decades, chronic obstructive pulmonary disease (COPD) has been considered a relentlessly progressive disease in which the deterioration of lung function is associated with an increase in symptoms, interrupted only by periods of exacerbation. However, this paradigm of COPD severity based on FEV1 has been challenged by currently available evidence. So far, three main approaches, though with contradictory aspects, have been proposed in order to address the complexity of COPD as well as to develop appropriate diagnostic, prognostic and therapeutic strategies for the disease: 1) the use of independent, clinically relevant variables, 2) the use of multidimensional indices, and 3) disease approaches based on clinical phenotypes. Multivariable systems seem superior to FEV1 in predicting prognosis and defining disease severity. However, selection of variables available from current literature must be confronted with issues of medical practice. Future evidence will be needed to reveal their effective relationship with disease long-term prognosis and to demonstrate the most adequate cutoff values to be used in clinical settings. Multidimensional scores provide a good prognostic instrument for the identification of patients with a particular degree of disease severity. Clinical phenotyping can help clinicians identify the patients who respond to specific pharmacological interventions; however, there is some controversy about the phenotypes to select and their long-term implications. Although these approaches are not perfect, they represent the first step towards patient-centered medicine for COPD. In the near-future, these different approaches should converge towards one new field to focus on the better management of COPD patients.
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Affiliation(s)
- Jose Luis Lopez-Campos
- 1Unidad Médico-quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain
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Llauger MA, Rosas A, Burgos F, Torrente E, Tresserras R, Escarrabill J. [Accesibility and use of spirometry in primary care centers in Catalonia]. Aten Primaria 2014; 46:298-306. [PMID: 24768654 PMCID: PMC6983645 DOI: 10.1016/j.aprim.2013.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 12/01/2013] [Accepted: 12/05/2013] [Indexed: 11/05/2022] Open
Abstract
Objetivo Conocer la accesibilidad y la utilización de la espirometría forzada (EF) en los dispositivos públicos de atención primaria en Cataluña. Diseño Estudio transversal mediante encuesta. Participantes Trescientos sesenta y seis equipos de atención primaria (EAP) de Cataluña. Tercer trimestre de 2010. Mediciones Encuesta con información relativa a los espirómetros, la formación, la interpretación y el control de calidad, y el grado de prioridad que la calidad de la espirometría tenía para el equipo. Se analizaron: media de EF/100 habitantes/año; índice de EF/mes/EAP; índice de EF/mes/10.000 habitantes. Resultados principales Porcentaje de respuesta: 75%. El 97,5% de los EAP dispone de espirómetro y realiza una media de 2,01 espirometrías/100 habitantes (34,68 espirometrías/EAP/mes). El 83% dispone de profesionales formados y más del 50% de los centros realizan formación reglada, pero no se dispone de información sobre la calidad de la misma. En el 70% se hace algún tipo de calibración. La interpretación la realiza el médico de familia en el 87,3% de los casos. En el 68% de los casos no se lleva a cabo ningún tipo de control de calidad de la exploración. En dos tercios de los casos se introducen manualmente los datos en la historia clínica informatiza. Más del 50% se atribuye una prioridad alta para las estrategias de mejora de la calidad de la EF. Conclusiones A pesar de la accesibilidad a la EF deben realizarse esfuerzos para estandarizar la formación, incrementar el número de exploraciones y promover el control de calidad sistemático.
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Affiliation(s)
- M Antònia Llauger
- EAP Encants, SAP Muntanya-Dreta de Barcelona, ICS, Barcelona, España; Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España.
| | - Alba Rosas
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Subdirecció de Planificació Sanitària, Direcció General de Planificació i Recerca en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Felip Burgos
- Centre Diagnòstic Respiratori, Institut del Tòrax, Hospital Clínic, IDIBAPS, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, España
| | - Elena Torrente
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Red de servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, España; Agència d'Informació, Avaluació i Qualitat en Salut (AIAQS), Barcelona, España
| | - Ricard Tresserras
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Subdirecció de Planificació Sanitària, Direcció General de Planificació i Recerca en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España; Observatori de Teràpies Respiratòries (OBsTRD), FORES, Vic (Barcelona), España
| | - Joan Escarrabill
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Red de servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, España; Observatori de Teràpies Respiratòries (OBsTRD), FORES, Vic (Barcelona), España; Programa d'Atenció a la Cronicitat, Hospital Clínic i Barcelona Esquerra, Barcelona, España
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Marina Malanda N, López de Santa María E, Gutiérrez A, Bayón JC, Garcia L, Gáldiz JB. Telemedicine spirometry training and quality assurance program in primary care centers of a public health system. Telemed J E Health 2014; 20:388-92. [PMID: 24476193 DOI: 10.1089/tmj.2013.0111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. MATERIALS AND METHODS The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). RESULTS In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (p<0.001). In the second phase, 7,200 spirometry tests were assessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; p<0.001). CONCLUSIONS (1) The quality of spirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.
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Affiliation(s)
- Nuria Marina Malanda
- 1 Respiratory Function Laboratory, Department of Pulmonology, Cruces University Hospital , Barakaldo, Bizkaia, Spain
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López-Campos JL, Soriano JB, Calle M. A comprehensive, national survey of spirometry in Spain: current bottlenecks and future directions in primary and secondary care. Chest 2014; 144:601-609. [PMID: 23411500 DOI: 10.1378/chest.12-2690] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We aimed to evaluate the availability and practice of spirometry, training of technicians, and spirometer features and maintenance in Spain in both primary care (PC) and secondary care (SC) centers. METHODS We used a nationwide, cross-sectional, 36-item telephone survey of health-care centers in Spain to target the technician in charge of conducting spirometries in PC and SC centers where outpatient respiratory patients are routinely evaluated. The questions surveyed for resources, training, spirometer use, bronchodilator tests, and spirometer features and maintenance. RESULTS Of a total of 1,259 centers screened, 605 PC centers (21.2% of the PC centers in Spain) and 200 SC centers (24.9% of the SC centers in Spain) were surveyed. The response rate was 85.4% for PC centers and 75.1% for SC centers. All together, 19% of screened centers did not have a spirometer or were not using it. The number of spirometers per center and spirometries conducted per week was higher in SC centers than in PC centers (P < .001). Most centers received training for conducting spirometries, but this was periodically done in < 40%. Most centers used two inhalations of salbutamol for the bronchodilator test, but the international criteria of a positive test was considered only in 55.8% of PC and 52.8% of SC centers. Calibration of the spirometer was never done in 10.5% of PC and 3.1% of SC centers. CONCLUSIONS This survey maps for the first time, to our knowledge, the current situation of spirometry in Spain, identifying bottlenecks and suggesting future directions applicable in both PC and SC centers and elsewhere.
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Affiliation(s)
- Jose Luis López-Campos
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid.
| | - Joan B Soriano
- Fundación Caubet-Cimera Islas Baleares, Bunyola, Mallorca, Illes Balears
| | - Myriam Calle
- Servicio de Neumología, Hospital Universitario San Carlos, Madrid, Spain
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Represas-Represas C, Botana-Rial M, Leiro-Fernández V, González-Silva AI, García-Martínez A, Fernández-Villar A. Short- and Long-Term Effectiveness of a Supervised Training Program in Spirometry Use for Primary Care Professionals. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Monteagudo M, Rodriguez-Blanco T, Llagostera M, Valero C, Bayona X, Granollers S, Ferro JJ, Acedo M, Almeda J, Rodriguez-Latre L, Muñoz L, Miravitlles M. Effect of health professional education on outcomes of chronic obstructive pulmonary disease in primary care: A non randomized clinical trial. Respirology 2013; 18:718-27. [DOI: 10.1111/resp.12074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/04/2012] [Accepted: 12/15/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Maria Llagostera
- Primary Care Service Baix Llobregat Centre; Catalan Health Institute; Cornellà de Llobregat; Spain
| | - Carles Valero
- Unit Methodology, Assessment and Quality; Catalan Health Institute; Barcelona; Spain
| | - Xavier Bayona
- Director City project Caldes de Montbui- Palau Solità i Plegamans; Catalan Health Institute; Cornellà; Spain
| | - Sílvia Granollers
- Primary Healthcare Centre Sant Just; Catalan Health Institute; Escola Universitària d'Infermeria (Universitat de Barcelona); Barcelona; Spain
| | - Juan J. Ferro
- Pharmacy Department DAP Costa de Ponent; Catalan Health Institute; Cornellà; Spain
| | - Mateo Acedo
- SAP Baix Llobregat Centre; Catalan Health Institute; Cornellà de Llobregat; Spain
| | - Jesús Almeda
- Research Support Unit; Primary Health Department Costa de Ponent; Catalan Health Institute; IDIAP Jordi Gol; CIBER Epidemiology and Public Health (CIBERESP); Cornellà de Llobregat; Spain
| | - Lluisa Rodriguez-Latre
- Unit Methodology, Assessment and Quality; SAP Baix Llobregat Centre; Catalan Health Institute; Cornellà de Llobregat; Spain
| | - Laura Muñoz
- Research Support Unit Metropolitana Nord; IDIAP Jordi Gol; Barcelona; Spain
| | - Marc Miravitlles
- Pneumology Department; Hospital Universitari Vall d'Hebron; Ciber de Enfermedades Respiratorias (CIBERES); Barcelona; Spain
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Represas-Represas C, Botana-Rial M, Leiro-Fernández V, González-Silva AI, García-Martínez A, Fernández-Villar A. Short- and long-term effectiveness of a supervised training program in spirometry use for primary care professionals. Arch Bronconeumol 2013; 49:378-82. [PMID: 23481409 DOI: 10.1016/j.arbres.2013.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/19/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries. METHODOLOGY Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1st day, 2nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month1, month2 and one year later. Participants also completed a survey about their satisfaction. RESULTS 74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1±1.9 on test 1; 7.5±1.6 on test 2; 8.9±1.3 on test 3, and 8.8±1.4 on test 4. During month1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (P<.05). CONCLUSIONS A training program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time.
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Serrano-Mollar A. [Alveolar epithelial cell injury as an etiopathogenic factor in pulmonary fibrosis]. Arch Bronconeumol 2012; 48 Suppl 2:2-6. [PMID: 23116901 PMCID: PMC7131261 DOI: 10.1016/s0300-2896(12)70044-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive accumulation of extracellular matrix and an imbalance between profibrotic and antifibrotic mediators. In the last few years, understanding of the mechanisms of the biology of IPF has increased. One of the most significant discoveries is the finding that alveolar epithelial cell injury plays an important role in the pathogenesis of this disease. In this review, we describe some of the mechanisms involved in alveolar cell injury and their contribution to the development of IPF.
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Affiliation(s)
- Anna Serrano-Mollar
- Departamento de Patología Experimental, Institut d'Investigacions Biomèdiques de Barcelona, España.
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Identifying patients at risk of late recovery (≥ 8 days) from acute exacerbation of chronic bronchitis and COPD. Respir Med 2012; 106:1258-67. [PMID: 22749710 DOI: 10.1016/j.rmed.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 04/04/2012] [Accepted: 06/01/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify factors associated with late recovery (≥ 8 days from exacerbation start) in patients with acute exacerbations of chronic bronchitis/COPD (AECB/AECOPD). METHODS An international, observational, non-interventional study in outpatients with AECB/AECOPD who received treatment for their exacerbation with the antibiotic moxifloxacin. Factors analyzed for late recovery included patient demographic characteristics, geographic region and disease severity. Additionally, logistic regression analysis was undertaken to identify factors associated with late recovery. RESULTS The analysis population was 40,435 patients aged ≥ 35 years, from Asia-Pacific, Europe, the Americas and Middle East/Africa. Most were male (63.1%), mean age 60.4 years and current or ex-smokers (60.6%) with history of ≥ 2 exacerbations in the previous year. Patients who underwent spirometry (n = 6408, 19.7%) had moderate airflow obstruction (mean FEV(1) 1.7 L). Both clinicians and patients reported that moxifloxacin provided clinical improvement in a mean of 3 days and recovery in 6 days. Clinical factors significantly associated with late recovery were: age ≥ 65 years, duration of chronic bronchitis >10 years, cardiac comorbidity, >3 exacerbations in the previous 12 months, current exacerbation type (Anthonisen I/II) and hospitalization in the last 12 months. CONCLUSIONS In a large cohort of patients, all treated with the same antibiotic for an exacerbation of chronic bronchitis or COPD, the main factors associated with late recovery (≥ 8 days) were: older age, history of frequent exacerbations, current exacerbation type of Anthonisen I/II, history of prior hospitalizations and cardiac comorbid conditions.
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Miravitlles M, Andreu I, Romero Y, Sitjar S, Altés A, Anton E. Difficulties in differential diagnosis of COPD and asthma in primary care. Br J Gen Pract 2012; 62:e68-75. [PMID: 22520766 PMCID: PMC3268496 DOI: 10.3399/bjgp12x625111] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 11/01/2011] [Accepted: 11/15/2011] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma treatment must be based on appropriate diagnosis. However, patients receiving inhaled therapy in primary care may not be accurately diagnosed according to current guidelines. AIM To analyse the characteristics of patients treated with inhaled medication, the concordance of tools for differential diagnosis, and the adequacy of prescription of inhaled corticosteroids (ICs) in primary care. DESIGN AND SETTING Cross-sectional, multicentre, non-interventional study conducted in 10 primary care centres in Barcelona, Spain. METHOD Patients with chronic respiratory disease, aged >40 years were treated with ICs. They provided sociodemographic and clinical information and performed forced spirometry with a bronchodilator test (BDT). The diagnostic accuracy of asthma and COPD diagnoses were tested using two differential diagnosis questionnaires. RESULTS A total of 328 patients were initially classified as having COPD (64.8%), asthma (15.4%), or indeterminate (19.8%) by their GPs. After spirometry, 40% of patients had moderate-severe airflow obstruction according to the GOLD classification; mean reversibility of forced expiratory volume in 1 second (FEV1) was 8.4%; 18.6% had a positive BDT; and 39.8% had post-bronchodilator FEV1/forced vital capacity >0.7. Concordance of the differential diagnosis tools was moderate (clinical diagnosis versus spirometry and between the two questionnaires), low (clinical diagnosis versus questionnaires), and very low (spirometry versus differential diagnosis). Of the patients diagnosed with COPD, 71.4% were treated with ICs, and 12% of those classified as having asthma were not receiving ICs. CONCLUSION Most patients can be classified as having COPD or asthma by primary care physicians. The use of the two questionnaires did not provide a better differential diagnostic compared with symptoms and spirometry with a BDT. Misdiagnosis may lead to inadequate treatment.
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Affiliation(s)
- Marc Miravitlles
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Ciber de Enfermedades Respiratorias (CIBERES), Hospital Clinic, Barcelona, Spain.
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Díaz-Grávalos GJ, Palmeiro-Fernández G, Valiño-López MD, Robles-Castiñeiras A, Fernández-Silva MJ, Reinoso-Hermida S, Casado-Górriz I. [The adequacy of the diagnostic in chronic obstructive pulmonary disease]. ACTA ACUST UNITED AC 2012; 27:305-10. [PMID: 22284432 DOI: 10.1016/j.cali.2011.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/19/2011] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the adequacy to the clinical guides (GOLD/SEPAR) for the diagnosis of the patients classified as COPD. MATERIAL AND METHODS We selected all COPD cases in the registry of chronic patients of 28 general practitioners from 9 Health Centres in the province of Ourense (Spain). A total of 382 cases were included. Diagnostic accuracy was determined according to the results of spirometry. We identify factors associated with correct diagnosis by logistic regression which included age, gender, residence (rural/urban), smoking, severity, level of follow up and time since diagnosis. RESULTS Of the total number included, 297 were male (77.7%) and 172 patients (45.0%) came from rural areas. The average age was 77.0 (SD=±11.0) years, with a mean age at diagnosis of 64.9 (±12.0) years and the time from diagnosis was 11.5 (±8.0) years. Less than half (49.1%) patients had been smokers, and 13.1% still smoked. Twenty-six cases (6.8%) were diagnosed in Primary Care. The FEV(1)/FVC ratio was recorded in 174 (45.5%) patients, with less than 0.7 in 138 cases (36.1%), which were considered as correctly diagnosed. In these patients the FEV(1) had been recorded in 125 cases (90.6%). A correct diagnosis was associated with severe or very severe disease (OR 5.2; 95% CI; 1.5-17.4), urban areas (OR 6.1; 95% CI, 1.7-21.2), and younger than 60 years (OR 3.7; 95% CI, 1.3-11.2). CONCLUSION The number of spirometry results recorded in the Primary Care medical records of patients diagnosed with COPD was found to be low, and with little adaptation to the accepted diagnostic criteria in the guidelines that are used routinely.
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Espinosa de los Monteros MJ, Peña C, Soto Hurtado EJ, Jareño J, Miravitlles M. Variability of Respiratory Symptoms in Severe COPD. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2011.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Llauger Roselló MA, Pou MA, Domínguez L, Freixas M, Valverde P, Valero C. [Treating COPD in chronic patients in a primary-care setting]. Arch Bronconeumol 2011; 47:561-70. [PMID: 22036593 DOI: 10.1016/j.arbres.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
The aging of the populations in Western countries entails an increase in chronic diseases, which becomes evident with the triad of age, comorbidities and polymedication. chronic obstructive pulmonary disease represents one of the most important causes of morbidity and mortality, with a prevalence in Spain of 10.2% in the population aged 40 to 80. In recent years, it has come to be defined not only as an obstructive pulmonary disease, but also as a systemic disease. Some aspects stand out in its management: smoking, the main risk factor, even though avoidable, is an important health problem; very important levels of underdiagnosis and little diagnostic accuracy, with inadequate use of spirometry; chronic patient profile; exacerbations that affect survival and cause repeated hospitalizations; mobilization of numerous health-care resources; need to propose integral care (health-care education, rehabilitation, promotion of self-care and patient involvement in decision-making).
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Espinosa de los Monteros MJ, Peña C, Soto Hurtado EJ, Jareño J, Miravitlles M. Variability of respiratory symptoms in severe COPD. Arch Bronconeumol 2011; 48:3-7. [PMID: 21944843 DOI: 10.1016/j.arbres.2011.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 06/05/2011] [Accepted: 07/15/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION While it is known that asthma symptoms have a very variable pattern, the general belief is that the respiratory symptoms in COPD patients usually present little or no variability. Nevertheless, COPD patients report having "bad days". The objective of this present study was to evaluate the variability of the respiratory symptoms and their impact on the daily activities of a cohort of Spanish COPD patients. METHOD We present the results of the Spanish patients who participated in a cross-sectional epidemiological study carried out in 17 European countries. Pulmonologists and Family Care physicians recruited patients with stable severe COPD (FEV1<50%). The perception of the patients on the variation in their symptoms was recorded by telephone interviews. RESULTS A total of 472 patients provided data that was valid for analysis. Mean age was 68.6; 93% were men; mean FEV1(%) was 41%. 84.1% of the patients experimented at least one respiratory symptom in the previous week and 60.9% affirmed that their symptoms varied over the course of the day or week. The moment of the day when the symptoms were perceived to be more intense was during the morning. CONCLUSIONS An important proportion of severe COPD patients perceive variability in their respiratory symptoms, with a greater intensity in the morning. The observation can have implications in treating patients with severe COPD as variability can be an initial sign of decompensation of the disease.
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Salas T, Rubies C, Gallego C, Muñoz P, Burgos F, Escarrabill J. Technical requirements of spirometers in the strategy for guaranteeing the access to quality spirometry. Arch Bronconeumol 2011; 47:466-9. [PMID: 21821333 DOI: 10.1016/j.arbres.2011.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 05/25/2011] [Accepted: 06/01/2011] [Indexed: 11/16/2022]
Abstract
Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosis of respiratory diseases, especially in those that are most frequent, such as COPD and asthma. This objective can be reached in the short term, but it requires the simultaneous integration of different strategies: training of the health-care professionals who perform spirometry, definition of standards for the transmission of the information, technical requirements for acquiring apparatuses and the correct interpretation of the results. This present study shows the use of standards for the electronic exchange of clinical information. In order to normalize the treatment of the data related with spirometry and to enable the exchange of information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7 (Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization that deals in the production of standards in the health-care setting in order to facilitate interoperability. Furthermore, defining these standards is essential for ensuring that they are adopted by spirometer manufacturers. Be means of this process, the base is set for facilitating access to spirometry at the health-care level, while at the same time it is a fundamental technical element for designing quality control programs of the explorations.
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Affiliation(s)
- Tomàs Salas
- Pla d'Imatge Mèdica, Agència d'Informació, Avaluació i Qualitat en Salut, Departament de Salut, Barcelona, España
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Burgos F. La espirometría forzada de calidad en Atención Primaria, impacto en el tratamiento de la EPOC. Arch Bronconeumol 2011; 47:224-5. [DOI: 10.1016/j.arbres.2011.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/02/2011] [Indexed: 11/25/2022]
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