1
|
Calle Rubio M, Miravitlles M, López-Campos JL, Alcázar Navarrete B, Soler Cataluña JJ, Fuentes Ferrer ME, Rodríguez Hermosa JL. Inhaled Maintenance Therapy in the Follow-Up of COPD in Outpatient Respiratory Clinics. Factors Related to Inhaled Corticosteroid Use. EPOCONSUL 2021 Audit. Arch Bronconeumol 2023; 59:725-735. [PMID: 37563018 DOI: 10.1016/j.arbres.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The aim of this analysis was to describe the patterns of inhaled maintenance therapy according to risk level and to explore the determinants associated with the decision to prescribe inhaled corticosteroids (ICS) in addition to bronchodilator therapy according to risk level as strategy in the follow-up of COPD in daily clinical practice. METHODS EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021 and January 31, 2022. RESULTS 4225 patients from 45 hospitals in Spain were audited. Risk levels were analyzed in 2678 patients. 74.5% of patients were classified as high risk and 25.5% as low risk according to GesEPOC criteria. Factors associated with the prescription of ICS in low-risk COPD were symptoms suggestive of asthma [OR: 6.70 (3.14-14.29), p<0.001], peripheral blood eosinophilia>300mm3 [OR: 2.16 (1.10-4.24), p=0.025], and having a predicted FEV1%<80% [OR: 2.17 (1.15-4.08), p=0.016]. In high-risk COPD, factors associated with triple therapy versus dual bronchodilator therapy were a mMRC dyspnea score of ≥2 [OR: 1.97 (1.41-2.75), p<0.001], symptoms suggestive of asthma [OR: 6.70 (3.14-14.29), p<0.001], and a predicted FEV1%<50% [OR: 3.09 (1.29-7.41), p<0.011]. CONCLUSIONS Inhaled therapy in the follow-up of COPD does not always conform to the current guidelines. Few changes in inhaled therapy are made at follow-up visits. The use of ICS is common in COPD patients who meet low-risk criteria in their follow-up and triple therapy in high-risk COPD patients is used as an escalation strategy in patients with high clinical impact. However, a history of exacerbations and eosinophil count in peripheral blood were not factors predicting triple therapy.
Collapse
Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marc Miravitlles
- Pulmonology 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
| | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| |
Collapse
|
2
|
Calle Rubio M, López-Campos JL, Miravitlles M, Soler Cataluña JJ, Alcázar Navarrete B, Fuentes Ferrer ME, Rodríguez Hermosa JL. Variations in Chronic Obstructive Pulmonary Disease Outpatient Care in Respiratory Clinics: Results From the 2021 EPOCONSUL Audit. Arch Bronconeumol 2023; 59:295-304. [PMID: 36858911 DOI: 10.1016/j.arbres.2023.02.004] [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: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION The aim of our work has been to describe the results of the clinical audit carried out in 2021 and to compare the results with 2015 EPOCONSUL audit. METHODS EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021, and January 31, 2022. RESULTS A total of 45 hospitals participated in the 2021 audit and 4.225 clinical records of patients were evaluated. Clinical phenotype according to the Spanish National Guidelines for COPD care (GesEPOC) was reported in 63.1% of the audited patients, and the COPD type assessment for the Global initiative for chronic Obstructive Lung Disease (GOLD) was present in 38.3%. There was an improved compliance with clinical practice guideline (CPG) recommendations in the 2021 audit with respect to the 2015 audit. There was an increase in the proportion of cases with alfa-1-antitrypsin serum level testing available (audit 1: 18.9%; audit 2: 38.7%, p<0.001) and 6-min walk test carried out (audit 1: 24%; audit 2: 45.2%, p<0.001). However, these significant variations adherence to CPG recommendations were not reached for the clinical evaluation and therapeutic intervention category when adjusting for patient and resource variables. CONCLUSIONS The 2021 EPOCONSUL audit showed increased adherence to recommendations although they seem to be related to the availability of resources for care. These results should be taken into account in order to establish improvements in resources to achieve a better quality of care.
Collapse
Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- Pulmonology 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
| | | | | | - Manuel E Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| |
Collapse
|
3
|
Nourian YH, Salimian J, Ahmadi A, Salehi Z, Karimi M, Emamvirdizadeh A, Azimzadeh Jamalkandi S, Ghanei M. cAMP-PDE signaling in COPD: Review of cellular, molecular and clinical features. Biochem Biophys Rep 2023; 34:101438. [PMID: 36865738 PMCID: PMC9971187 DOI: 10.1016/j.bbrep.2023.101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death among non-contagious diseases in the world. PDE inhibitors are among current medicines prescribed for COPD treatment of which, PDE-4 family is the predominant PDE isoform involved in hydrolyzing cyclic adenosine monophosphate (cAMP) that regulates the inflammatory responses in neutrophils, lymphocytes, macrophages and epithelial cells The aim of this study is to investigate the cellular and molecular mechanisms of cAMP-PDE signaling, as an important pathway in the treatment management of patients with COPD. In this review, a comprehensive literature review was performed about the effect of PDEs in COPD. Generally, PDEs are overexpressed in COPD patients, resulting in cAMP inactivation and decreased cAMP hydrolysis from AMP. At normal amounts, cAMP is one of the essential agents in regulating metabolism and suppressing inflammatory responses. Low amount of cAMP lead to activation of downstream inflammatory signaling pathways. PDE4 and PDE7 mRNA transcript levels were not altered in polymorphonuclear leukocytes and CD8 lymphocytes originating from the peripheral venous blood of stable COPD subjects compared to healthy controls. Therefore, cAMP-PDE signaling pathway is one of the most important signaling pathways involved in COPD. By examining the effects of different drugs in this signaling pathway critical steps can be taken in the treatment of this disease.
Collapse
Affiliation(s)
- Yazdan Hasani Nourian
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Jafar Salimian
- Applied Virology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Zahra Salehi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Emamvirdizadeh
- Department of Molecular Genetics, Faculty of Bio Sciences, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - Sadegh Azimzadeh Jamalkandi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran,Corresponding author.
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Erfan A, Khalil M, Elmaraghy A, Abd Elkader M. Ultrasonographic assessment of diaphragmatic performance in two chronic obstructive pulmonary disease phenotypes admitted with acute exacerbation and its relation to outcome. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
|
5
|
Is it time to readjust the doses of inhaled corticosteroids in COPD? ARCHIVOS DE BRONCONEUMOLOGÍA 2022; 58:593-594. [DOI: 10.1016/j.arbres.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
|
6
|
López-Campos JL, Jiménez-Ruiz CA, Meneses Petersen ED, Rabade Castedo C, Asensio Sánchez S, Vaquero Lozano P, Ferrer Espinosa S, Pérez Soriano MDP, de Higes Martínez E, García de Llanos C, Pastor Esplá E, Cabrera César E, Mogrovejo S, Riesco Miranda JA, Barrueco Ferrero M, Callejas González FJ, Sandoval Contreras R, Peña Miguel T, Peris Cardells R, González Dou MV, Guzmán Aguilar JM, Amado CA, Gorordo Unzueta MI, Rois Seijas P, Martínez Muñiz MA, Naval Sendra E, Granda-Orive JID, Signes-Costa J. [Translated article] Smoking Cessation Units as a Source of COPD Diagnoses: Project 1000-200. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
7
|
Miravitlles M, Calle M, Molina J, Almagro P, Gómez JT, Trigueros JA, Cosío BG, Casanova C, López-Campos JL, Riesco JA, Simonet P, Rigau D, Soriano JB, Ancochea J, Soler-Cataluña JJ. [Translated article] Spanish COPD guidelines (GesEPOC) 2021: Updated pharmacological treatment of stable COPD. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
8
|
Miravitlles M, Calle M, Molina J, Almagro P, Gómez JT, Trigueros JA, Cosío BG, Casanova C, López-Campos JL, Riesco JA, Simonet P, Rigau D, Soriano JB, Ancochea J, Soler-Cataluña JJ. Spanish COPD Guidelines (GesEPOC) 2021: Updated Pharmacological treatment of stable COPD. Arch Bronconeumol 2022; 58:69-81. [PMID: 33840553 DOI: 10.1016/j.arbres.2021.03.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 01/16/2023]
Abstract
The Spanish COPD Guidelines (GesEPOC) were first published in 2012, and since then have undergone a series of updates incorporating new evidence on the diagnosis and treatment of COPD. GesEPOC was drawn up in partnership with scientific societies involved in the treatment of COPD and the Spanish Patients' Forum. Their recommendations are based on an evaluation of the evidence using GRADE methodology, and a narrative description of the evidence in areas in which GRADE cannot be applied. In this article, we summarize the recommendations on the pharmacological treatment of stable COPD based on 9 PICO questions. COPD treatment is a 4-step process: 1) diagnosis, 2) determination of the risk level, 3) initial and subsequent inhaled therapy, and 4) identification and management of treatable traits. For the selection of inhaled therapy, high-risk patients are divided into 3 phenotypes: non-exacerbator, eosinophilic exacerbator, and non-eosinophilic exacerbator. Some treatable traits are general and should be investigated in all patients, such as smoking or inhalation technique, while others affect severe patients in particular, such as chronic hypoxemia and chronic bronchial infection. COPD treatment is based on long-acting bronchodilators with single agents or in combination, depending on the patient's risk level. Eosinophilic exacerbators must receive inhaled corticosteroids, while non-eosinophilic exacerbators require a more detailed evaluation to choose the best therapeutic option. The new GesEPOC also includes recommendations on the withdrawal of inhaled corticosteroids and on indications for alpha-1 antitrypsin treatment. GesEPOC offers a more individualized approach to COPD treatment tailored according to the clinical characteristics of patients and their level of complexity.
Collapse
Affiliation(s)
- Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos. Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | | | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, Terrassa, España
| | | | | | - Borja G Cosío
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, España
| | - Ciro Casanova
- Servicio de Neumología-Unidad de Investigación, Hospital Universitario Nuestra Señora de La Candelaria. Universidad de La Laguna, Tenerife, España
| | - José Luis López-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Juan Antonio Riesco
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España
| | - Pere Simonet
- Centro de Salud Viladecans-2, Atención Primaria Costa de Ponent-Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Departament de Ciències Clíniques, Universitat Barcelona, Barcelona, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Joan B Soriano
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario de La Princesa. Universidad Autónoma de Madrid, Madrid, España
| | - Julio Ancochea
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario de La Princesa. Universidad Autónoma de Madrid, Madrid, España
| | - Juan José Soler-Cataluña
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, España
| |
Collapse
|
9
|
López-Campos JL, Carrasco Hernández L, Ruiz-Duque B, Reinoso-Arija R, Caballero-Eraso C. Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies. Int J Chron Obstruct Pulmon Dis 2021; 16:2065-2076. [PMID: 34285480 PMCID: PMC8285922 DOI: 10.2147/copd.s275943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
Recent advances in inhaled drugs and a clearer definition of the disease have made the task of managing COPD more complex. Different proposals have been put forward which combine all the available treatments and the different clinical presentations in an effort to select the best therapeutic options for each clinical context. As COPD is a chronic progressive disease, the escalation of therapy has traditionally been considered the most natural way to tackle it. However, the notion of COPD as a constantly progressing disease has recently been challenged and, in specific areas, this points to the possibility of a de-escalation in treatment. In this context, the clinician requires simple, specific recommendations to guide these changes in treatment in their daily clinical practice. To accomplish this, the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the patient's condition. Thereafter, the first escalation in therapy must be introduced with caution as the disease progresses, since clinical trials are not designed with clinical decision-making in mind. During this escalation, three possibilities are open to change the current treatment for a different one within the same family, to increase non-pharmacological interventions or to increase the pharmacological therapies. Beyond that point, a patient with persistent symptoms represents a complex clinical scenario which requires a specialized approach, including the evaluation of different respiratory and non-respiratory comorbidities. Unfortunately, there are few de-escalation studies available, and these are mainly observational in nature. The debate on de-escalation in pharmacological treatment, therefore, involves two main discussion points: the withdrawal of bronchodilators and the withdrawal of inhaled steroids. Altogether, the scheme for modifying treatment must be more personalized than just adding molecules, and the therapeutic response and its conditioning factors should be evaluated at each step before proceeding further.
Collapse
Affiliation(s)
- Jose Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Carrasco Hernández
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Borja Ruiz-Duque
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Rocio Reinoso-Arija
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Candelaria Caballero-Eraso
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
10
|
López-Campos JL, Jiménez-Ruiz CA, Meneses Petersen ED, Rabade Castedo C, Asensio Sánchez S, Vaquero Lozano P, Ferrer Espinosa S, Pérez Soriano MDP, de Higes Martínez E, García de Llanos C, Pastor Esplá E, Cabrera César E, Mogrovejo S, Riesco Miranda JA, Barrueco Ferrero M, Callejas González FJ, Sandoval Contreras R, Peña Miguel T, Peris Cardells R, González Dou MV, Guzmán Aguilar JM, Amado CA, Gorordo Unzueta MI, Rois Seijas P, Martínez Muñiz MA, Naval Sendra E, Granda-Orive JID, Signes-Costa J. Smoking Cessation Units as a Source of COPD Diagnoses: Project 1000-200. Arch Bronconeumol 2021; 58:S0300-2896(21)00169-1. [PMID: 34158184 DOI: 10.1016/j.arbres.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/09/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022]
Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | | | | | - Carlos Rabade Castedo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | | | | | | | | | | | | | | | - Eva Cabrera César
- Servicio de Neumología, Hospital Virgen de la Victoria, Málaga, España
| | | | - Juan Antonio Riesco Miranda
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Miguel Barrueco Ferrero
- Servicio de Neumología, Hospital Clínico de Salamanca, Universidad de Salamanca, Salamanca, España
| | | | | | - Teresa Peña Miguel
- Servicio de Neumología, Complejo Asistencial Universitario de Burgos, Burgos, España
| | | | | | | | - Carlos A Amado
- Servicio de Neumología, Hospital Marqués de Valdecilla, Santander, España
| | | | | | | | | | | | - Jaime Signes-Costa
- Servicio de Neumología, Hospital Clínico de Valencia, INCLIVA, Valencia, España
| |
Collapse
|
11
|
Spanish COPD guidelines (GesEPOC) 2021: Updated pharmacological treatment of stable COPD. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.arbr.2021.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
12
|
Schroeder M, Benjamin N, Atienza L, Biswas C, Martin A, Whalen JD, Izquierdo Alonso JL, Riesco Miranda JA, Soler-Cataluña JJ, Huerta A, Ismaila AS. Cost-Effectiveness Analysis of a Once-Daily Single-Inhaler Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease (COPD) Using the FULFIL Trial: A Spanish Perspective. Int J Chron Obstruct Pulmon Dis 2020; 15:1621-1632. [PMID: 32764908 PMCID: PMC7360413 DOI: 10.2147/copd.s240556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/24/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose To evaluate the cost-effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs twice-daily budesonide/formoterol (BUD/FOR) in patients with symptomatic chronic obstructive pulmonary disease (COPD) at risk of exacerbations, from the Spanish National Healthcare System perspective. Patients and Methods The validated GALAXY-COPD model was used to simulate disease progression and predict healthcare costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 3-year time horizon for a Spanish population. Patient characteristics from published literature were supplemented by data from FULFIL (NCT02345161), which compared FF/UMEC/VI vs BUD/FOR in patients with symptomatic COPD at risk of exacerbations. Treatment effects, extrapolated to 3 years, were based on Week 24 results in the FULFIL intent-to-treat population, including change in forced expiratory volume in 1 second, St. George’s Respiratory Questionnaire score, and exacerbation rates. Treatment, exacerbations, and COPD management costs (2019€) were informed by Spanish public sources and published literature. A 3% discount rate for costs and benefits was applied. One-way sensitivity and scenario analyses, and probabilistic sensitivity analysis (PSA), were performed. Results FF/UMEC/VI treatment led to fewer moderate and severe exacerbations (2.126 and 0.306, respectively) vs BUD/FOR (2.608 and 0.515, respectively), with a mean incremental cost of €69 and gain of 0.107 QALYs, which resulted in an ICER of €642 per QALY gained. In sensitivity analyses, the ICER was most sensitive to treatment effect variations in exacerbations and healthcare resource utilization/event costs. Overall, 95% of 1000 PSA simulations resulted in an ICER less than €11,000 per QALY gained for FF/UMEC/VI vs BUD/FOR, confirming robustness of the results. The probability of FF/UMEC/VI being cost-effective vs BUD/FOR was 100% at a willingness-to-pay threshold of €30,000 per QALY gained. Conclusion At the accepted Spanish ICER threshold of €30,000, FF/UMEC/VI represents a cost-effective treatment option vs BUD/FOR in patients with symptomatic COPD at risk of exacerbations.
Collapse
Affiliation(s)
| | | | | | | | - Alan Martin
- Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, UK
| | | | | | - Juan Antonio Riesco Miranda
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
13
|
Hurst JR, Quint JK, Stone RA, Silove Y, Youde J, Roberts CM. National clinical audit for hospitalised exacerbations of COPD. ERJ Open Res 2020; 6:00208-2020. [PMID: 32984418 PMCID: PMC7502696 DOI: 10.1183/23120541.00208-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Exacerbations of COPD requiring hospital admission are burdensome to patients and health services. Audit enables benchmarking performance between units and against national standards, and supports quality improvement. We summarise 23 years of UK audit for hospitalised COPD exacerbations to better understand which features of audit design have had most impact. METHOD Pilot audits were performed in 1997 and 2001, with national cross-sectional audits in 2003, 2008 and 2014. Continuous audit commenced in 2017. Overall, 96% of eligible units took part in cross-sectional audit, 86% in the most recent round of continuous audit. We synthesised data from eight rounds of national COPD audit. RESULTS Clinical outcomes were observed to change at the same time as changes in delivery of care: length of stay halved from 8 to 4 days between 1997 and 2014, alongside wider availability of integrated care. Process indicators did not generally improve with sequential cross-sectional audit. Under continuous audit with quality improvement support, process indicators linked to financial incentives (early specialist review (55-66%) and provision of a discharge bundle (53-74%)) improved more rapidly than those not linked (availability of spirometry (40-46%) and timely noninvasive ventilation (21-24%)). CONCLUSION Careful piloting and engagement can result in successful roll-out of cross-sectional national audit in a high-burden disease. Audit outcome measures and process indicators may be affected by changes in care pathways. Sequential cross-sectional national audit alone was not generally accompanied by improvements in care. However, improvements in process indicators were seen when continuous audit was combined with quality improvement support and, in particular, financial incentives.
Collapse
Affiliation(s)
- John R. Hurst
- National Asthma and COPD Audit Programme, Royal College of Physicians, London, UK
- UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Jennifer K. Quint
- National Asthma and COPD Audit Programme, Royal College of Physicians, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Yvonne Silove
- National Clinical Audit and Patient Outcomes Programme, Healthcare Quality Improvement Partnership, London, UK
| | - Jane Youde
- Care Quality Improvement Dept, Royal College of Physicians, London, UK
| | - C. Michael Roberts
- National Asthma and COPD Audit Programme, Royal College of Physicians, London, UK
- School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
14
|
Erro Iribarren M, Alonso Pérez T, Soriano JB, Ancochea Bermúdez J. Adecuación del nivel de intervención en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) según la estratificación de riesgo propuesta por la Guía española de la EPOC (GesEPOC) versión 2017. Arch Bronconeumol 2020; 56:183-185. [DOI: 10.1016/j.arbres.2019.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/15/2019] [Accepted: 09/22/2019] [Indexed: 11/30/2022]
|
15
|
Sicras Mainar A, Huerta A, Navarro Artieda R, Monsó E, Landis SH, Ismaila AS. Economic impact of delaying initiation with multiple-inhaler maintenance triple therapy in Spanish patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2121-2129. [PMID: 31571848 PMCID: PMC6748313 DOI: 10.2147/copd.s211854] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Guidelines recommend the use of triple therapy with an inhaled corticosteroid (ICS), a long-acting β2 agonist (LABA) and a long-acting muscarinic antagonist (LAMA) to reduce the risk of future exacerbations in symptomatic COPD patients with a history of exacerbations. This study aimed to estimate COPD-related healthcare resource use and costs, and subsequent exacerbation rates, for patients initiating multiple-inhaler triple therapy (MITT) early (≤30 days) versus late (31–180 days) following an exacerbation, in a real-world clinical setting. Patients and methods This was an observational, longitudinal, retrospective study using electronic medical records from the Spanish database of the Red de Investigación en Servicios Sanitarios Foundation. Patients ≥40 years old with a confirmed COPD diagnosis who were newly prescribed MITT up to 180 days after an exacerbation between January 2013 and December 2015 were included. Patients were followed from the date of MITT initiation for up to 12 months to assess COPD-related health care resource use (routine and emergency visits, hospitalizations, pharmacologic treatment), exacerbation rate, and costs (€2017); these endpoints were compared between early versus late groups. Results The study included 1280 patients who met selection criteria: mean age 73 years, 78% male, and 41% had severe/very severe lung function impairment. The proportion of patients initiating MITT early versus late was 61.6% versus 38.4%, respectively. There were no statistically significant differences in baseline characteristics between groups. During follow-up, health care resource consumption was lower in the early versus late group, especially primary care and ED visits, leading to lower total costs (€1861 versus €1935; P<0.05). In the follow-up period, 28.0% of the patients in the early group experienced ≥1 exacerbation versus 36.4% in the late group (P=0.002), with an exacerbation rate of 0.5 versus 0.6 per person per year (P=0.022), respectively. Conclusion Initiating MITT early (≤30 days after an exacerbation) may reduce health care costs and exacerbation rate compared with late MITT initiation.
Collapse
Affiliation(s)
- Antoni Sicras Mainar
- Scientific Direction, Health Economics and Outcomes Research (HEOR) Department, Real Life Data, Madrid, Spain
| | - Alicia Huerta
- Market Access Department, GlaxoSmithKline SA, Madrid, Spain
| | - Ruth Navarro Artieda
- Medical Documentation Department, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Eduard Monsó
- Pulmonology Service, Hospital Parc Taulí, Barcelona, Spain.,CIBERES - Ciber De Enfermedades Respiratorias, Madrid, Spain
| | - Sarah H Landis
- Real World Evidence and Epidemiology Department, GlaxoSmithKline, Uxbridge, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes Department, GlaxoSmithKline, Collegeville, PA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
16
|
Ragaišienė G, Kibarskytė R, Gauronskaitė R, Giedraitytė M, Dapšauskaitė A, Kasiulevičius V, Danila E. Diagnosing COPD in primary care: what has real life practice got to do with guidelines? Multidiscip Respir Med 2019; 14:28. [PMID: 31516702 PMCID: PMC6732826 DOI: 10.1186/s40248-019-0191-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The role of primary care physician in COPD management varies in different health care systems. According to the researches in various countries, extent of spirometry use in diagnosing and grading COPD frequently remains insufficient. Inaccurate diagnosis results in mistreatment and disease progression.The aims of our study were to investigate the accuracy of COPD diagnosis, grading, and treatment according to guidelines in daily practice of primary care. METHODS A retrospective analysis of ambulatory records in a large primary care center was conducted. Digital medical records of current patients were screened for ICD-10-AM codes J44.0, J44.1, J44.8 and J44.9. All medical records starting from the first visit in this primary care center were reviewed. RESULTS Two hundred twenty-eight patients diagnosed with COPD were included in the study, 118 male, mean age 67 yrs. (SD 14). A spirometry report was available to 58% of the patients, 75% of them met the guidelines for COPD diagnosis. The grade was correct for 56.8% of the patients. 54% were consulted by the pulmonologist at least once. After re-analyzing spirometry, correcting the diagnosis, and grading, it was determined that only 70% of the patients were receiving appropriate treatments. Sixteen per cent of patients were undertreated and 14% were overtreated. CONCLUSIONS COPD care in primary practice remains suboptimal. Incorrect approach often leads to incorrect grading and mistreatment. Points for improvement should be identified in further studies.
Collapse
Affiliation(s)
- Greta Ragaišienė
- Clinic of Internal Diseases, Family Medicine and Oncology of Vilnius University, Santariškių st. 2, Vilnius, Lithuania
- Center of Family Medicine of Vilnius University Hospital Santaros Klinikos, Taikos st, 104-52, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Rūta Kibarskytė
- Clinic of Chest Diseases and Allergology of Vilnius University, Vilnius, Lithuania
- Center of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Rasa Gauronskaitė
- Clinic of Chest Diseases and Allergology of Vilnius University, Vilnius, Lithuania
- Center of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Monika Giedraitytė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Agnė Dapšauskaitė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Vytautas Kasiulevičius
- Clinic of Internal Diseases, Family Medicine and Oncology of Vilnius University, Santariškių st. 2, Vilnius, Lithuania
- Center of Family Medicine of Vilnius University Hospital Santaros Klinikos, Taikos st, 104-52, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Edvardas Danila
- Clinic of Chest Diseases and Allergology of Vilnius University, Vilnius, Lithuania
- Center of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| |
Collapse
|
17
|
Calle Rubio M, Soler-Cataluña JJ, López-Campos JL, Alcázar Navarrete B, Rodríguez González-Moro JM, Soriano JB, Fuentes Ferrer ME, Rodriguez Hermosa JL. Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit. PLoS One 2019; 14:e0211732. [PMID: 30726278 PMCID: PMC6364994 DOI: 10.1371/journal.pone.0211732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the main reasons for healthcare appointments and use of healthcare resources. In recent years, clinics specializing in COPD have been developed to offer improved care and optimization of recourses for patients with high complexity and frequent decompensations. However, little is known about the clinical practice in this clinical model specializing in COPD. The objectives of this study were to assess the prevalence, characteristics of specialized COPD outpatient respiratory clinics and to evaluate clinical practice in this healthcare model. METHODS EPOCONSUL is a Spanish nationwide, observational, cross-sectional, clinical audit with prospective case recruitment including the clinical records for 4508 COPD cases from outpatient respiratory clinics over a 12-month period (May 2014-May 2015). The study evaluated clinical practice in 2378 cases from 28 hospitals with both general and specialized COPD outpatient respiratory clinics. RESULTS Only 28 (47.5%) centers had an outpatient clinic specializing in COPD, which was characterized by longer patient visits and a higher prevalence of written protocols compared to a general clinic. Patients treated in a specialized clinic had greater obstruction severity, a higher degree of dyspnea and also suffered from more comorbidities. The majority of patients at both types of clinic were classified as high risk (81.1% versus 83%, p = 0.384) according to GesEPOC criteria. Clinical control of COPD was more frequent at specialized clinics, with significant differences in non-severe patients (70.5% versus 56.1%, p < 0.001). Testing was done more frequently in specialized clinics, with better adherence to good clinical practice recommendations. CONCLUSION A specialized COPD outpatient clinic is a healthcare model found in few pulmonology departments that treats more severe patients and those with increased comorbidities. The COPD patients treated in a specialized clinic had a better clinical control, as defined by impact and clinical stability. It is a healthcare model to offer improved care with a higher degree of adherence to guidelines.
Collapse
Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel E. Fuentes Ferrer
- Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Preventative Medicine CMU, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Juan Luis Rodriguez Hermosa
- Pulmonology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- * E-mail:
| |
Collapse
|
18
|
Kopsaftis ZA, Sulaiman NS, Mountain OD, Carson-Chahhoud KV, Phillips PA, Smith BJ. Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: systematic review. Syst Rev 2018; 7:213. [PMID: 30497532 PMCID: PMC6264607 DOI: 10.1186/s13643-018-0860-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is a lack of guidelines for the use of short-acting bronchodilators (SABD) in people admitted to hospital for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), despite routine use in practice and risk of cardiac adverse events. AIM To review the evidence that underpins use and optimal dose, in terms of risk versus benefit, of SABD for inpatient management of AECOPD and collate the results for future guidelines. METHODS Medline, Embase, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov and International Clinical Trials Registry Platform were searched (inception to November 2017) for published and ongoing studies. Included studies were randomised controlled trials or controlled clinical trials investigating the effect of SABD (β2-agonist and/or ipratropium) on inpatients with a diagnosis of AECOPD. This review was undertaken in accordance with PRISMA guidelines and a pre-defined protocol. Due to heterogeneous methodologies, meta-analysis was not possible so the results were synthesised qualitatively. RESULTS Of 1378 studies identified, 10 met inclusion criteria. Narrative synthesis of 10 studies revealed no significant differences in most outcomes of interest relative to dose, delivery via inhaler or nebuliser, and type of β2-agonist used. However, some evidence demonstrated significantly increased cardiac side effects with increased dosage of β2-agonist (45% versus 24%), P<0.05). CONCLUSION This review identified a paucity of methodologically rigorous evidence evaluating use of SABD among AECOPD. The available evidence did not identify any additional benefits for participants receiving higher doses of short-acting β2-agonists compared to lower doses, or based on type of delivery method or β2-agonists used. However, there was a small increase in some adverse events for participants using higher doses of β2-agonists.
Collapse
Affiliation(s)
- Zoe A Kopsaftis
- Faculty of Health Science, Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
- Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
- Respiratory Medicine Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
| | - Nur S Sulaiman
- Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Oliver D Mountain
- Faculty of Health Science, Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kristin V Carson-Chahhoud
- Faculty of Health Science, Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Paddy A Phillips
- Department of Medicine, Flinders University, Adelaide, South Australia, Australia
- SA Health, Government of South Australia, Adelaide, South Australia, Australia
| | - Brian J Smith
- Faculty of Health Science, Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Respiratory Medicine Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| |
Collapse
|
19
|
Driessen MT, Whalen J, Seewoodharry Buguth B, Vallejo-Aparicio LA, Naya IP, Asukai Y, Alcázar-Navarrete B, Miravitlles M, García-Río F, Risebrough NA. Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective. Respir Res 2018; 19:224. [PMID: 30458866 PMCID: PMC6245710 DOI: 10.1186/s12931-018-0916-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV1) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature. METHODS This analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum. RESULTS UMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO. CONCLUSION UMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) treatments can be considered cost effective in Spain.
Collapse
Affiliation(s)
- M. T. Driessen
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS UK
| | - J. Whalen
- ICON Health Economics, ICON plc, Abingdon, UK
| | | | | | - I. P. Naya
- Global Respiratory Franchise, GSK, Brentford, Middlesex, UK
| | - Y. Asukai
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS UK
| | | | - M. Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | | | | |
Collapse
|
20
|
Soler-Cataluña JJ, Marzo M, Catalán P, Miralles C, Alcazar B, Miravitlles M. Validation of clinical control in COPD as a new tool for optimizing treatment. Int J Chron Obstruct Pulmon Dis 2018; 13:3719-3731. [PMID: 30532528 PMCID: PMC6241720 DOI: 10.2147/copd.s178149] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It has recently been proposed that the concept of clinical control in COPD may be useful for deciding treatment in COPD, but the original control criteria (OCC) were considered too restrictive. Objective Define and subsequently validate "modified" control criteria (MCC) of COPD. Method Prospective observational study in COPD patients with a 1-year follow-up. Control was defined as the presence of low clinical impact and clinical stability. To evaluate clinical impact, the following clinical parameters were assessed: the degree of dyspnea, use of rescue medication, physical activity, and sputum color. Stability was assessed by clinical changes and exacerbations in the last 3 months. The COPD assessment test score and their changes were also evaluated as alternative control criteria. To define the MCC, adjustment for disease severity using BODEx index (MCC-B) or FEV1 (MCC-F) was evaluated, and the best cutoff point was established. Time to first combined event (emergency visit, hospitalization, or death) was analyzed to evaluate the predictive capacity of risk of the OCC, MCC-B, and MCC-F. Results We included 265 patients, 224 (83.9%) men, with a mean age (±SD) of 68±9 years and FEV1 of 58%±17%. The proportion of controlled patients was higher using clinical MCC-B or MCC-F (61.5% and 59.6%) than OCC (27.5%). Similar percentages were found using COPD assessment test scores. The time to the first combined event was significantly greater in controlled patients using MCC criteria (P<0.001, all cases). The predictive capacity of risk was similar in MCC-B (c-statistic [C]=0.639) and MCC-F (C=0.637) and higher than OCC (C=0.589). Conclusions The new MCC identified a higher number of controlled COPD patients. These patients have a better quality of life and lower risk of poor outcomes. The concept of control and the new MCC could be a useful tool to optimize therapy.
Collapse
Affiliation(s)
- Juan José Soler-Cataluña
- Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain.,CIBER of Respiratory Diseases (CIBERES), Spain,
| | - Maribel Marzo
- Emergency Department, Hospital General de Requena, Valencia, Spain
| | - Pablo Catalán
- Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Bernardino Alcazar
- CIBER of Respiratory Diseases (CIBERES), Spain, .,Respiratory Department, Hospital de Alta Resolución de Loja, Granada, Spain
| | - Marc Miravitlles
- CIBER of Respiratory Diseases (CIBERES), Spain, .,Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Barcelona, Spain,
| |
Collapse
|
21
|
Diab N, Gershon AS, Sin DD, Tan WC, Bourbeau J, Boulet LP, Aaron SD. Underdiagnosis and Overdiagnosis of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2018; 198:1130-1139. [DOI: 10.1164/rccm.201804-0621ci] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Nermin Diab
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea S. Gershon
- Department of Medicine, The University of Toronto, Toronto, Ontario, Canada
| | - Don D. Sin
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wan C. Tan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada; and
| | | | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
22
|
Lopez-Campos JL, Navarrete BA, Soriano JB, Soler-Cataluña JJ, González-Moro JMR, Ferrer MEF, Rubio MC. Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit. Int J Chron Obstruct Pulmon Dis 2018; 13:2279-2288. [PMID: 30100718 PMCID: PMC6067777 DOI: 10.2147/copd.s160842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy. Methods EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014–May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models. Results Patterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other nonspecified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype. Conclusion The EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs.
Collapse
Affiliation(s)
- Jose Luis Lopez-Campos
- Medical-Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain, .,CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain,
| | | | - Joan B Soriano
- Research Institute, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain.,Research Unit, Instituto de Investigación del Hospital Clínico San Carlos, Madrid, Spain.,Clinical Management Unit, Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid, Spain
| | - Myriam Calle Rubio
- Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain.,Research Unit, Instituto de Investigación del Hospital Clínico San Carlos, Madrid, Spain.,Pneumology Department, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
23
|
Calle Rubio M, Soriano JB, López- Campos JL, Soler-Cataluña JJ, Alcázar Navarrete B, Rodríguez González- Moro JM, Miravitlles M, Barrecheguren M, Fuentes Ferrer ME, Rodriguez Hermosa JL. Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study. PLoS One 2018; 13:e0198777. [PMID: 29953442 PMCID: PMC6023216 DOI: 10.1371/journal.pone.0198777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing. METHODS EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics. RESULTS A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05). CONCLUSION Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.
Collapse
Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, España
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España
- * E-mail:
| | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Consultant on Methodology and Research of SEPAR, Universidad Autónoma de Madrid, Madrid, España
| | - José Luis López- Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid. España
| | | | - Bernardino Alcázar Navarrete
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid. España
- Pulmonary Department, Hospital de Alta Resolución de Loja, Granada, España
| | | | - Marc Miravitlles
- Pulmonary Department, Hospital Universitari Vall d’Hebron, Barcelona, España
- CIBER de Enfermedades Respiratorias (CIBERES). Barcelona, España
| | | | - Manuel E. Fuentes Ferrer
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España
- UGC de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan Luis Rodriguez Hermosa
- Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, España
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España
| | | |
Collapse
|
24
|
Soler-Cataluña JJ. Guías de práctica clínica o medicina personalizada en la enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2018; 54:247-248. [DOI: 10.1016/j.arbres.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 01/09/2023]
|
25
|
Calle Rubio M, Rodríguez Hermosa JL, Soler-Cataluña JJ, López-Campos JL, Alcazar Navarrete B, Soriano JB, Rodríguez Gónzalez-Moro JM, Fuentes Ferrer ME, Miravitlles M. Atención médica según el nivel de riesgo y su adecuación a las recomendaciones de la guía española de la enfermedad pulmonar obstructiva crónica (EPOC) (GesEPOC): Estudio EPOCONSUL. Arch Bronconeumol 2018; 54:270-279. [DOI: 10.1016/j.arbres.2017.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
|
26
|
Lopez-Campos JL, Centanni S. Current Approaches for Phenotyping as a Target for Precision Medicine in COPD Management. COPD 2018; 15:108-117. [PMID: 29558165 DOI: 10.1080/15412555.2018.1443064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The study of airway diseases continues to present several challenges for modern medicine. The different disease presentations with variables and overlapping features may result in a real challenge for the clinician. In this context, the concept of precision medicine has started to emerge in order to give answers to some of these challenges from a diagnostic and therapeutic point of view. The main reasons to target for precision medicine in chronic obstructive pulmonary disease (COPD) include that there is variability in the clinical presentation, there is no correlation between the different clinical variables at the patient level, there are a number of relevant clinical variables associated with outcomes, we do have specific therapies for specific patient types, and that there is variability in the clinical response to different therapies. To bring precision medicine into clinical practice several approaches have been used, including the use of independent variables to identify subjects, the use of multidimensional indexes, the so-called clinical phenotypes, and the approximation by the so-called treatable traits. All these approaches have their strengths and weaknesses which are reviewed in the present document. Although there is no universally accepted proposal, the available initiatives provide us with a framework on which to start working and move toward precision medicine in COPD, with the ultimate goal of bringing the best possible medicine to each patient in particular.
Collapse
Affiliation(s)
- Jose Luis Lopez-Campos
- a Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla , Seville , Spain.,b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid , Spain
| | - Stefano Centanni
- c Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences , Università degli Studi di Milano , Milan , Italy
| |
Collapse
|
27
|
Miravitlles M, Molina J, Quintano JA, Campuzano A, Pérez J, Roncero C. Depressive status explains a significant amount of the variance in COPD assessment test (CAT) scores. Int J Chron Obstruct Pulmon Dis 2018; 13:823-831. [PMID: 29563782 PMCID: PMC5846753 DOI: 10.2147/copd.s154791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD assessment test (CAT) is a short, easy-to-complete health status tool that has been incorporated into the multidimensional assessment of COPD in order to guide therapy; therefore, it is important to understand the factors determining CAT scores. Methods This is a post hoc analysis of a cross-sectional, observational study conducted in respiratory medicine departments and primary care centers in Spain with the aim of identifying the factors determining CAT scores, focusing particularly on the cognitive status measured by the Mini-Mental State Examination (MMSE) and levels of depression measured by the short Beck Depression Inventory (BDI). Results A total of 684 COPD patients were analyzed; 84.1% were men, the mean age of patients was 68.7 years, and the mean forced expiratory volume in 1 second (%) was 55.1%. Mean CAT score was 21.8. CAT scores correlated with the MMSE score (Pearson's coefficient r=-0.371) and the BDI (r=0.620), both p<0.001. In the multivariate analysis, the usual COPD severity variables (age, dyspnea, lung function, and comorbidity) together with MMSE and BDI scores were significantly associated with CAT scores and explained 45% of the variability. However, a model including only MMSE and BDI scores explained up to 40% and BDI alone explained 38% of the CAT variance. Conclusion CAT scores are associated with clinical variables of severity of COPD. However, cognitive status and, in particular, the level of depression explain a larger percentage of the variance in the CAT scores than the usual COPD clinical severity variables.
Collapse
Affiliation(s)
- Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, Spain
| | | | | | | | - Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain
| | | |
Collapse
|
28
|
Villar-Álvarez F, Moreno-Zabaleta R, Mira-Solves JJ, Calvo-Corbella E, Díaz-Lobato S, González-Torralba F, Hernando-Sanz A, Núñez-Palomo S, Salgado-Aranda S, Simón-Rodríguez B, Vaquero-Lozano P, Navarro-Soler IM. Do not do in COPD: consensus statement on overuse. Int J Chron Obstruct Pulmon Dis 2018; 13:451-463. [PMID: 29440883 PMCID: PMC5799849 DOI: 10.2147/copd.s151939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). Methods A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. Results In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Conclusion Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.
Collapse
Affiliation(s)
| | - Raúl Moreno-Zabaleta
- Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Alcázar-Navarrete B, Castellano Miñán F, Romero Palacios PJ. Futuro de la triple terapia en la enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2018; 54:63-64. [DOI: 10.1016/j.arbres.2017.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
|
30
|
Aisanov Z, Avdeev S, Arkhipov V, Belevskiy A, Chuchalin A, Leshchenko I, Ovcharenko S, Shmelev E, Miravitlles M. Russian guidelines for the management of COPD: algorithm of pharmacologic treatment. Int J Chron Obstruct Pulmon Dis 2018; 13:183-187. [PMID: 29386887 PMCID: PMC5764288 DOI: 10.2147/copd.s153770] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and nonpharmacologic measures for all patients, and the decision not to use the letters A-D for simplicity and clarity. At all stages of the treatment algorithm, efficacy and safety have to be carefully assessed. Escalation and de-escalation is possible in the case of lack of or insufficient efficacy or safety issues. Bronchodilators should not be discontinued except in the case of significant side effects. At the same time, inhaled corticosteroid (ICS) withdrawal is not represented in the algorithm, because it was agreed that there is insufficient evidence to establish clear criteria for ICSs discontinuation. Finally, based on the Global Initiative for Obstructive Lung Disease statement, the proposed algorithm reflects and summarizes different approaches to the pharmacological treatment of COPD taking into account the reality of health care in the Russian Federation.
Collapse
Affiliation(s)
- Zaurbek Aisanov
- Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia
| | - Sergey Avdeev
- Clinical Department, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
| | | | - Andrey Belevskiy
- Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia
| | - Alexander Chuchalin
- Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia
| | - Igor Leshchenko
- Department of Phthisiology, Pulmonology and Thoracic Surgery, Ural State Medical University, Healthcare Ministry of Russia, Ekaterinburg
| | - Svetlana Ovcharenko
- Internal Medicine Department No.1, I.M. Sechenov First Moscow State Medical University, Healthcare Ministry of Russia
| | - Evgeny Shmelev
- Department of Differential Diagnostics, Federal Central Research Institute of Tuberculosis, Moscow, Russia
| | - Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| |
Collapse
|
31
|
Bethencourt Martín N, Figueira Gonçalves JM, Díaz Pérez D. Vacunación antineumocócica en el paciente con enfermedad pulmonar obstructiva crónica: una asignatura a mejorar. Med Clin (Barc) 2018; 150:41. [DOI: 10.1016/j.medcli.2017.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 10/18/2022]
|
32
|
Calle Rubio M, López-Campos JL, Soler-Cataluña JJ, Alcázar Navarrete B, Soriano JB, Rodríguez González-Moro JM, Fuentes Ferrer ME, Rodríguez Hermosa JL. Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study. Respir Res 2017; 18:200. [PMID: 29197415 PMCID: PMC5712134 DOI: 10.1186/s12931-017-0685-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. METHODS EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. RESULTS A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. CONCLUSION To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.
Collapse
Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain.
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad of Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Joan B Soriano
- Research Institute of Hospital University La Princesa (IISP), University Autónoma of Madrid, Madrid, Spain
| | | | - Manuel E Fuentes Ferrer
- UGC de Medicina Preventiva, Research Institute of Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain
| | | |
Collapse
|
33
|
Miravitlles M, Cosío BG, Arnedillo A, Calle M, Alcázar-Navarrete B, González C, Esteban C, Trigueros JA, Rodríguez González-Moro JM, Quintano Jiménez JA, Baloira A. A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease. Respir Res 2017; 18:198. [PMID: 29183382 PMCID: PMC5706374 DOI: 10.1186/s12931-017-0682-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/15/2017] [Indexed: 01/24/2023] Open
Abstract
According to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting β2 agonist therapy is recommended in patients with moderate-to-severe disease and an increased risk of exacerbations. However, ICS are largely overprescribed in clinical practice, and most patients are unlikely to benefit from long-term ICS therapy.Evidence from recent randomized-controlled trials supports the hypothesis that ICS can be safely and effectively discontinued in patients with stable COPD and in whom ICS therapy may not be indicated, without detrimental effects on lung function, health status, or risk of exacerbations. This article summarizes the evidence supporting the discontinuation of ICS therapy, and proposes an algorithm for the implementation of ICS withdrawal in patients with COPD in clinical practice.Given the increased risk of potentially serious adverse effects and complications with ICS therapy (including pneumonia), the use of ICS should be limited to the minority of patients in whom the treatment effects outweigh the risks.
Collapse
Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Borja G Cosío
- CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain
| | - Aurelio Arnedillo
- Pneumology, Allergy and Thoracic Surgery Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Medicine Department, University of Cádiz, Cádiz, Spain
| | - Myriam Calle
- Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Bernardino Alcázar-Navarrete
- Respiratory Department, AIG de Medicina, Hospital de Alta Resolución de Loja, Agencia Sanitaria Hospital de Poniente, Loja, Granada, Spain
| | - Cruz González
- Department of Respiratory Medicine, Hospital Clínico Universitario and Instituto de Investigación Sanitaria (INCLIVA) Valencia, Valencia, Spain
| | - Cristóbal Esteban
- Pneumology Department of Hospital Galdakao-Usansolo, Biscay, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | | | | | | | - Adolfo Baloira
- Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| |
Collapse
|
34
|
Clinical Guidelines in Asthma and Chronic Obstructive Pulmonary Disease: How Useful Are They in Clinical Practice? Arch Bronconeumol 2017; 54:117-118. [PMID: 28918869 DOI: 10.1016/j.arbres.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/20/2022]
|
35
|
Calle Rubio M, Casamor R, Miravitlles M. Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study. Int J Chron Obstruct Pulmon Dis 2017; 12:2373-2383. [PMID: 28848338 PMCID: PMC5557116 DOI: 10.2147/copd.s137872] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The Spanish Guidelines for COPD (GesEPOC) describe four clinical phenotypes: non-exacerbator (NE), asthma-COPD overlap syndrome (ACO), frequent exacerbator with emphysema (EE), and exacerbator with chronic bronchitis (ECB). The objective of this study was to determine the frequency of COPD phenotypes, their clinical characteristics, and the availability of diagnostic tools to classify COPD phenotypes in clinical practice. Materials and methods This study was an epidemiological, cross-sectional, and multi-centered study. Patients ≥40 years old with a post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio of <0.7 and who were smokers or former smokers (with at least 10 pack-years) were included. The availability of diagnostic tools to classify COPD phenotypes was assessed by an ad hoc questionnaire. Results A total of 647 patients (294 primary care [PC], 353 pulmonology centers) were included. Most patients were male (80.8%), with a mean age (SD) of 68.2 (9.2) years, mean post-bronchodilator FEV1 was 53.2% (18.9%) and they suffered a mean of 2.2 (2.1) exacerbations in the last year. NE was the most frequent phenotype (47.5%) found, followed by ECB (29.1%), EE (17.0%), and ACO (6.5%). Significant differences between the four phenotypes were found regarding age; sex; body mass index; FEV1; body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE)/body mass index, airflow obstruction, dyspnea and exacerbations (BODEx) index; modified Medical Research Council dyspnea scale; respiratory symptoms; comorbidi-ties; hospitalizations; and exacerbations in the last year. Physicians considered that >80% of the diagnostic tools needed to classify COPD phenotypes were available, with the exception of computed tomography (26.9%) and carbon monoxide transfer test (13.5%) in PC, and sputum eosinophilia count in PC and pulmonology centers (40.4% and 49.4%, respectively). Conclusion In Spanish clinical practice, almost half of the patients with COPD presented with NE phenotype. The prevalence of ACO according to the Spanish consensus definition was very low. In general, physicians indicated that they had the necessary tools for diagnosing COPD phenotypes.
Collapse
Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Hospital Clínico San Carlos.,Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid
| | | | - Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| |
Collapse
|
36
|
Sobradillo Ecenarro P, García-Rivero JL. GOLD 2017: The Spanish Perspective. Arch Bronconeumol 2017. [PMID: 28625723 DOI: 10.1016/j.arbres.2017.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
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]
|
38
|
|
39
|
Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, Trigueros JA, Cosío BG, Casanova C, Riesco JA, Simonet P, Rigau D, Soriano JB, Ancochea J. Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
40
|
The Rationale for GesEPOC in Our Environment. Arch Bronconeumol 2017; 53:293-294. [PMID: 28495074 DOI: 10.1016/j.arbres.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 11/24/2022]
|
41
|
Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, Trigueros JA, Cosío BG, Casanova C, Antonio Riesco J, Simonet P, Rigau D, Soriano JB, Ancochea J. Spanish Guidelines for Management of Chronic Obstructive Pulmonary Disease (GesEPOC) 2017. Pharmacological Treatment of Stable Phase. Arch Bronconeumol 2017; 53:324-335. [PMID: 28477954 DOI: 10.1016/j.arbres.2017.03.018] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 01/04/2023]
Abstract
The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype. In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes. These regimens were subsequently adopted by other national guidelines, and since then, have been backed up by new evidence. In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients. The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with bronchitis. Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients. High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype. GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity.
Collapse
Affiliation(s)
- Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España.
| | | | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, España
| | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, Terrassa, España
| | | | | | - Borja G Cosío
- Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Ciro Casanova
- Servicio de Neumología-Unidad de Investigación, Hospital Universitario La Candelaria, Tenerife, España
| | | | - Pere Simonet
- Centro de Salud Viladecans-2, Dirección Atención Primaria Costa de Ponent-Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de La Princesa (IISP), Universidad Autónoma de Madrid, Consultor Metodológico y de Investigación de SEPAR, Madrid, España
| | - Julio Ancochea
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación, Hospital Universitario de La Princesa (IISP), Universidad Autónoma de Madrid, Madrid, España
| |
Collapse
|