Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos

Miguel-Díez, Javier de; Alonso, José L.; París, Jesús Molina; González-Moro, José Miguel Rodríguez; Ramos, Pilar; Alonso-Vega, G. Gaspar

doi:10.1016/s0300-2896(03)75362-9

Cited by 46 publications

(7 citation statements)

References 14 publications

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“…In this study, 22.5% of the selected patients did not undergo a spirometry test (32.1% in PC and 11.1% in pulmonology centers) and 21% of the patients did not show airflow obstruction in the spirometry test (30.3% in PC and 12.1% in pulmonology centers). The incorrect diagnosis of COPD and the limited use of spirometry testing in the assessment of respiratory symptoms are similar to that reported by prior studies conducted in Spain, where <50% of the individuals with a COPD diagnosis in primary care had performed a spirometry test 18 , 19 or where COPD was incorrectly diagnosed in 31% and 14% of patients seen in primary care or specialized sites, respectively. 20 Nevertheless, there are some methodological considerations that should be borne in mind regarding the sites that participated in this study.…”

Section: Discussionsupporting

confidence: 81%

Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study

Rubio¹,

Casamor²,

Miravitlles

2017

COPD

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BackgroundThe 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 methodsThis 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.ResultsA 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).ConclusionIn 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.

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Section: Discussionsupporting

confidence: 81%

Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study

Rubio¹,

Casamor²,

Miravitlles

2017

COPD

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“…Different studies have documented a widespread underuse of spirometry by general practitioners to establish COPD diagnosis [ 13 – 17 ]. De Miguel Díez et al [ 14 ] assessed the methods used by primary care physicians and chest physicians to diagnose COPD in Spain and analyzed the factors affecting the correct diagnosis of the disease. Their results indicated that primary care physicians classified 29.3% of the patients correctly, whereas chest physicians diagnosed 84.8% correctly.…”

Section: Discussionmentioning

confidence: 99%

“…Spirometry was available to 49.1% of the primary care physicians and 97.8% of the chest physicians. Moreover, only 29.9% of the primary care settings had a technician in charge of performing the measurements, in comparison with 97.8% of the specialized chest physician settings [ 14 ]. De Miguel Díez et al [ 14 ] also indicated that the use of spirometry in diagnosing COPD was related to the level of patient care (primary or specialist) and the availability of the test in the primary care setting.…”

Section: Discussionmentioning

confidence: 99%

COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study

Herrera

Varela

et al. 2016

PLoS ONE

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BackgroundAcknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay.ObjectivesTo assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting.MethodsCOPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed.Results1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I–II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry.ConclusionsCOPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting.

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“…Como ya hemos señalado anteriormente uno de los problemas más comunes e importantes a la hora de realizar las maniobras de la espirometría por profesionales no expertos es la dificultad para obtener una adecuada determinación de la capacidad vital forzada (FVC), parámetro esencial para poder definir la alteración obstructiva [111][112] . Por este motivo se ha propuesto que el FEV 6 , más fácil de determinar, puede ser un sustituto aceptable de la FVC para el diagnóstico de obstrucción en adultos 91 .…”

Section: Dispositivo Copd-6unclassified

“…Los beneficios que es posible obtener del diagnóstico precoz de la EPOC son prevenir o retrasar el deterioro de la función pulmonar, el refuerzo de la intervención sobre los factores de riesgo (tabaco), la disminución de costes sanitarios directos e indirectos y por último una intervención terapéutica precoz.Sin embargo, salvo excepciones, la implantación de la espirometría en atención primaria es una experiencia fallida, lo que obliga a buscar métodos alternativos para el diagnóstico, que resuelvan algunas de las causas que han dificultado la implementación de la espirometría. Nuestro estudio, con todas las limitaciones que presenta, pretende aportar ideas y sistemas validados para facilitar esa labor de detección precoz de la EPOC mediante un dispositivo de fácil manejo, que no necesita de una formación técnica compleja por parte de los profesionales, que resulta sencillo al paciente, que es barato, de fácil transporte y que no necesita de calibraciones periódicas.Uno de los errores más comunes a la hora de realizar las maniobras de la espirometría por profesionales no expertos es que, debido a la dificultad para obtener una adecuada determinación de la capacidad vital forzada (FVC), no es posible definir con exactitud las alteraciones obstructivas[111][112] . Por este motivo se ha propuesto que el volumen espiratorio forzado en 6 segundos (FEV 6 ), parámetro más fácil de determinar, puede ser un sustituto aceptable de la FVC para el diagnóstico de la obstrucción en adultos91 .…”

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Utilidad del dispositivo portátil PIKO6 para la detección precoz de EPOC en Atención Primaria

Sierra¹

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Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos

Cited by 46 publications

References 14 publications

Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study

Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study

COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study

Utilidad del dispositivo portátil PIKO6 para la detección precoz de EPOC en Atención Primaria

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