Sex Differences in the International Primary Care Airways Group Questionnaire for Screening of Chronic Obstructive Pulmonary Disease: A Retrospective, Cross-Sectional Study

Background and Objective

Methods

Results

Conclusion

Usefulness of The Piko-6 Portable Device for Early COPD Detection in Primary Care

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.

[Over-diagnosis of chronic obstructive pulmonary disease in Primary Care. Prevalence and determining factors]

INTRODUCTION

COPD under-diagnosis is common in Primary Health Care medicine, due to the low use of spirometry, but there is less information about over-diagnosis of the disease in patients that have a clinical diagnosis of COPD.

OBJECTIVE

The main objective of the study was to investigate the prevalence of COPD over-diagnosis in Primary Care medicine. Secondary objectives were to determine the factors associated with an incorrect clinical diagnosis of COPD and to analyse whether the pharmacological treatment is different for patients with correct or incorrect diagnosis.

METHOD

A prospective, observational, cross-sectional study was conducted using the spirometry results of 206 patients with a clinical diagnosis of COPD, with no prior lung function testing, and who were treated with inhaled therapy. Characteristics and treatment of patients with a correct or incorrect COPD diagnosis were compared.

RESULTS

The prevalence of COPD over-diagnosis was 42.7% in the study population. Factors associated with an incorrect diagnosis were female sex (P<.0001), obesity (P=.009), absence of smoking history (P<.0001), lower age (P=.001), and less severe dyspnoea (P=.001). Long-acting muscarinic agents were more frequently prescribed to patients with a correct COPD diagnosis. There were no other differences regarding inhaled therapies between both groups.

CONCLUSIONS

Over-diagnosis is a frequent phenomenon in patients with a clinical diagnosis of COPD managed in Primary Care medicine. There are different features between patients with a correct and incorrect diagnosis. Spirometry is an essential tool to reduce COPD over-diagnosis.

Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting

OBJECTIVE

To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method.

MATERIALS AND METHODS

The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied.

RESULTS

TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013).

CONCLUSION

The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method.

[ARAPOC Study: Prevalence of respiratory symptoms and chronic obstructive pulmonary disease in the general population]

Objetivo

El objetivo de este trabajo fue conocer la prevalencia de síntomas respiratorios y de EPOC, así como las características de esta población en Aragón (España).

Diseño y emplazamiento

Estudio epidemiológico, transversal, en población entre 40 y 75 años. Los sujetos fueron elegidos de forma aleatoria y estratificada por edad y sexo a partir de los datos de la tarjeta sanitaria del Servicio Aragonés de Salud.

Participantes

Un total de 1.185 sujetos aceptaron colaborar.

Mediciones principales

Un cuestionario sociodemográfico y clínico y espirometría forzada antes y después de una prueba broncodilatadora. El diagnóstico de EPOC se realizaba según los criterios de la guía GOLD (cociente FEV₁/CVF < 0,7).

Resultados

La prevalencia de EPOC alcanzó un 10,4% (IC: 9,8-11,0%), un 16,9% en hombres y un 5,7% en mujeres. Los síntomas respiratorios aparecieron en un 58% de la población general. Existía mayor prevalencia de EPOC en las mujeres que en otros estudios. Los factores asociados a desarrollar EPOC fueron ser hombre, tener más edad, mayor índice tabáquico y menor nivel de estudios. El 78,9% de los pacientes con EPOC no estaban diagnosticados. Los diagnosticados fueron de más edad, más fumadores, con EPOC más graves o con peor calidad de vida.

Conclusiones

La alta prevalencia de EPOC y el importante nivel de infradiagnóstico nos permite creer que el diagnóstico precoz de esta enfermedad es todavía una asignatura pendiente. Necesitamos desarrollar nuevas estrategias para atajar este problema.

Inter-regional changes in the performance and interpretation of spirometry in Spain: 3E study

OBJECTIVES

This report shows the results of a nation-wide survey on spirometry to assess regional differences.

METHODS

Observational cross-sectional study conducted by means of a telephone survey in 805 primary care (PC) and specialized centers (SC) in all regions. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test.

RESULTS

The results showed major differences between regions. Most centers had 1-2 spirometers. The number of spirometry tests per week ranged from 2 to 8.9 in PC and between 34.3 and 98.3 in SC. Some training had been given in most centers (63.6-100% in PC and 60.0-100% in SC) but not on a regular basis. Most centers used several short-acting bronchodilators for the bronchodilation test, but with insufficient inhalations (2.0-3.8 in PC and 2.0-3.3 in SC) and frequently incorrect waiting time (29.4-83.3% PC and 33.3-87.5% in SC). Daily calibration was not performed in all centers (0-100% in PC and 66.7-100% in SC). Significant inter-regional differences in spirometry quality criteria were observed, with 6 or more criteria met in 9.1-84.6% of PC centers and 37.5-100% in SC.

CONCLUSIONS

Our results show the current situation of spirometry in primary and specialized care in Spain, highlighting considerable variability and areas for improvement. This information should be considered by health officials to improve the quality and accessibility of such tests.

[Accesibility and use of spirometry in primary care centers in Catalonia]

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.

Identifying patients at risk of late recovery (≥ 8 days) from acute exacerbation of chronic bronchitis and COPD

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.

Difficulties in differential diagnosis of COPD and asthma in primary care

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.

[The adequacy of the diagnostic in chronic obstructive pulmonary disease]

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.

[Treating COPD in chronic patients in a primary-care setting]

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).

[Validation of the Spanish version of the Chronic Obstructive Pulmonary Disease-Population Screener (COPD-PS). Its usefulness and that of FEV₁/FEV₆ for the diagnosis of COPD]

BACKGROUND AND OBJECTIVES

The chronic obstructive pulmonary disease (COPD) is a highly undiagnosed disease. The use of short screening questionnaires designed to detect chronic airflow obstruction may help to the early diagnosis of COPD.

PATIENTS AND METHOD

This was an observational, cross-sectional epidemiological study aimed to validate the translated into Spanish version of the COPD-PS questionnaire. Socio-demographic and clinical data of participants were collected, as well as their answers to the COPD-PS and EQ-5D questionnaires. The ratio FEV(1)/FEV(6) was measured with the COPD-6 device. The psychometric properties of the questionnaire and the diagnostic yield of the FEV(1)/FEV(6) ratio were analysed, both referred to the gold standard of post-bronchodilator FEV(1)/FVC < 0.7.

RESULTS

Ten primary care centers participated in the study and included 94 controls and 79 cases with chronic airflow obstruction. Questionnaire characteristics were: feasibility, 2.3% of participants did not answer at least one item; mean time to fill the questionnaire was 47.7 seconds; 4.7% of individuals had a 0 score. Validity, moderate correlation with EQ-5D scores and moderate-high with FEV(1); the scores of COPD-PS were related to all parameters associated with COPD. A cut off of 4 units had the best sensitivity/specificity ratio and correctly classified 78% of participants. For the FEV(1)/FEV(6) ratio, a cut off of 0.75 correctly classified 85% of individuals.

CONCLUSIONS

The COPD-PS questionnaire demonstrated good psychometric properties. A cut off score of 4 has excellent predictive value. A ratio of 0.75 in the FEV(1)/FEV(6) provides an excellent correlation with the ratio FEV(1)/FVC and is useful for the identification of individuals with chronic airflow obstruction.

Variability of respiratory symptoms in severe COPD

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.

Socioeconomic status and health-related quality of life of patients with chronic obstructive pulmonary disease

BACKGROUND

Socioeconomic status (SES) is an important determinant of health and premature death. However, the impact of poor SES on the health status of patients with chronic obstructive pulmonary disease (COPD) has not been well determined.

OBJECTIVE

It was our aim to assess the impact of SES on the quality of life in COPD patients.

METHODS

This was a cross-sectional, observational, multicenter study. A total of 4,574 patients completed the EuroQol 5-dimension questionnaire (EQ-5D) and the Airways Questionnaire 20 (AQ20). SES was based on the subject's occupation and educational level. Occupational categories were based on the major group classification of the International Standard Classification of Occupations.

RESULTS

The mean age of the population was 67.1 years and the mean forced expiratory volume was 43.4%. There was a gradient of impairment in health-related quality of life (HRQoL) according to the educational level, with significantly worse scores for the EQ-5D and the AQ20 for medium and low educational levels compared with high education (p < 0.001). Similarly, HRQoL was also significantly impaired in more unskilled workers, with a gradient of the AQ20 from 8.6 units (SD 4.8) in class I to 10.1 units (4.6) in class V (p < 0.001) and from 0.75 units in class I to 0.63 units in class V for the EQ-5D index, as well as from 62.9 units in class I to 55.6 units in class V for the EQ-5D visual analogue scale (p < 0.001 for all comparisons). These differences remained significant after controlling for covariates.

CONCLUSIONS

Patients with a lower educational level and belonging to the unskilled professional groups had a poorer HRQoL. This is evident even in a country where access to health care services is universal and free.

Variability in the performing of spirometry and its consequences in the treatment of COPD in primary care

BACKGROUND

Several studies have approached the use of spirometry in the treatment of chronic obstructive pulmonary disease (COPD) in Primary Care (PC), but few have analysed its impact on the treatment of the patient with COPD.

OBJECTIVES

To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, and its impact on treatment. To analyse the variation in the performing of spirometry between PC centres.

METHODOLOGY

A multicentre, observational and cross-sectional study of COPD patients seen in PC in Catalonia (Spain) during 2004-2005. A multilevel logistic regression model was used to identify factors associated with having spirometry and to determine the variation between the different centres.

RESULTS

Twenty-one centres which included 801 patients took part. Only 53.2% of them had a diagnostic spirometer available and the mean (standard deviation) FEV1(%) was 54.8% (18%). The registers of smoking habits, complementary tests and spirometry follow-up were more common among patients who had a diagnostic spirometry available compared to those who did not. No statistically significant differences were found as regards demographic, clinical, treatment and quality of life variables between patients with and without follow-up spirometry. Significant variation was observed in the percentage of diagnostic spirometries between different PC centres (variance=0.217; p<0.001).

CONCLUSION

Spirometry is underused in PC and performing it during follow-up is not associated to the different treatments received, or with a more complete approach to the disease. There is significant variation in the performing of spirometry among PC centres.

New horizons in early stage COPD--improving knowledge, detection and treatment

Early stage COPD carries a significant healthcare burden that is currently underrecognised, underdiagnosed and undertreated. Furthermore, patients at this stage can rapidly decline to advanced disease, especially if they continue to smoke. The natural history of the disease in early stages remains largely unknown, and emerging evidence indicates that we are able to reduce lung function decline and exacerbations, and improve quality of life, in early stage COPD, mainly through smoking cessation. But new evidence from randomised clinical trials also suggests an impact of pharmacotherapy on clinical outcomes in early disease. Guidelines need to be updated to reflect this greater understanding of early stage disease, and trials need to be conducted to definitively show the benefits of intensive treatment so that we can meet the large, unmet clinical needs of this important patient group.

Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): information and health education feedback for improving clinical monitoring and quality-of-life

Background

Chronic obstructive pulmonary disease (COPD) is a health problem that is becoming increasingly attended-to in Primary Care (PC). However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG). The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL) of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education.

Method/Design

Multi-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC) within the administrative area of the Costa de Ponent (near Barcelona). All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse) derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy). The sample random includes a total of 801 patients (≥ 40 years of age), recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical Research Council (MRC) and the QoL, evaluated with the St George's Respiratory Questionnaire (SGRQ). The variables are obtained at the start and the end of the intervention. Information from follow-up visits focuses on the changes in life-style activities of the patient.

Discussion

This study is conducted with the objective of generating evidence that shows that implementation of awareness programs directed towards health-care professionals as well as patients in the context of PC can produce an increase in the QoL and a decrease in the disease exacerbation, compared to standard clinical practice.

Trial Registration

Clinical Trials.gov Identifier: NCT00922545;

Progression of chronic obstructive pulmonary disease: impact of inflammation, comorbidities and therapeutic intervention

BACKGROUND AND AIM

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and through under-diagnosis, is often inappropriately treated. This multicomponent disease involves both airway and systemic inflammation at all stages and may influence the progression of disease and the pathophysiology of comorbidities. This review examines evidence linking inflammation, disease progression and comorbidities in COPD, and the potential role of anti-inflammatory therapies.

METHODS

Systematic searches of Medline and Cochrane Reviews databases from 1976 to March 2008 using the terms: chronic obstructive pulmonary disease, disease progression, inflammation, inflammatory, comorbid condition, comorbidity, treatment, therapy, bronchodilator, inhaled corticosteroid.

FINDINGS

Increased levels of interleukin-8, tumour necrosis factor-alpha and systemic C-reactive protein correlate with worse disease severity, exacerbation rates and lung function decline. Increased systemic C-reactive protein is also associated with poorer health status and comorbidities (e.g. cardiovascular disease, cancer and skeletal muscle dysfunction). The pivotal role of inflammation in the pathogenesis of COPD and its comorbidities suggests anti-inflammatory therapies will be important in the overall management of COPD. Long-term studies indicate that combination therapies consisting of a long-acting beta-agonist plus an inhaled corticosteroid in one inhaler have the potential to modify disease progression through positive effects on lung function, exacerbations, symptoms and health status. The TOwards a Revolution in COPD Health (TORCH) study is the first to demonstrate that a COPD pharmacotherapy (combination salmeterol plus fluticasone propionate) significantly decreased the rate of lung function decline versus placebo.

CONCLUSION

Better understanding of the specific inflammatory mechanisms underlying COPD disease progression and associated comorbidities will likely lead to more effective management of the disease.

Use of spirometry and patterns of prescribing in COPD in primary care

OBJECTIVE

To investigate the use and interpretation of spirometry in primary care (PC) in the diagnosis of chronic obstructive pulmonary disease (COPD) and to identify the treatment schedules administered.

METHODS

An observational study was performed in a randomized sample of 251 PC physicians including 2130 patients with COPD. Data on the performance of spirometry and the results and the treatment administered were collected as were sociodemographic and clinical data.

RESULTS

Spirometric results were obtained in 1243 (58.4%). Most (1118/1243; 89.9%) corresponded to FEV1 (%) values with a mean of 57% (SD=21.5%). It is of note that only 31.8% of spirometric results provided post-bonchodilator results, and 42.9% and 43.1% of the spirometries presented not plausible FVC or FEV1 values, respectively. Treatment varied greatly, with more than 3 drugs being prescribed in 30.6% of the cases. Long-acting beta-2 agonists and inhaled corticosteroids were prescribed in more than 50% of the patients. Tiotropium was administered in 32.4%. According to the GOLD guidelines, 22.8% of the patients in GOLD II, 50% in III and 66.7% in IV were receiving incorrect treatment.

CONCLUSIONS

Only 58.4% of the cases included had undergone spirometry. Important deficiencies were observed in the interpretation of the results of spirometry. These difficulties may influence the low implementation of treatment guidelines in COPD in PC.