Variabilidad en la realización de la espirometría y sus consecuencias en el tratamiento de la EPOC en Atención Primaria

Monteagudo, Mónica; Rodríguez-Blanco, Teresa; Parcet, Judith; Peñalver, N. Díaz; Rubio, Carles; Ferrer, Montse; Miravitlles, Marc

doi:10.1016/j.arbres.2010.10.009

Cited by 37 publications

(6 citation statements)

References 25 publications

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“…In our study, only 40% of the patients had undergone spirometry with an available FEV1 measurement, which is consistent with previous data from primary care in our country 9 , 11 , 12 and in other European countries. 13 – 15 Moreover, along the 12 months after the initiation of the therapy, a follow-up spirometry was performed in only one quarter of the patients in each group.…”

Section: Discussionsupporting

confidence: 93%

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

Barrecheguren

Monteagudo

Miravitlles

2018

npj Prim Care Resp Med

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This epidemiological study aimed to describe and compare the characteristics and outcomes of COPD patients starting treatment with a long-acting anti-muscarinic (LAMA) or a combination of a long-acting beta-2 agonist (LABA)/LAMA in primary care in Catalonia (Spain) over a one-year period. Data were obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database containing information of 5.8 million inhabitants (80% of the population of Catalonia). Patients initiating treatment with a LAMA or LABA/LAMA in 2015 were identified, and information about demographic and clinical characteristics was collected. Then, patients were matched 1:1 for age, sex, FEV1%, history of exacerbations, history of asthma and duration of treatment, and the outcomes between the two groups were compared. During 2015, 5729 individuals with COPD started treatment with a LAMA (69.8%) or LAMA/LABA (30.2%). There were no remarkable differences between groups except for a lower FEV1 and more previous hospital admissions in individuals on LABA/LAMA. The number of tests and referrals was low and decreased in both groups during follow-up. For the same severity status, the evolution was similar with a reduction in exacerbations in both groups. Treatment was changed during follow-up in up to 34.2% of patients in the LABA/LAMA and 26.3% in the LAMA group, but adherence was equally good for both. Our results suggest that initial therapy with LAMA in monotherapy may be adequate in a significant group of mild to moderate patients with COPD and a low risk of exacerbations managed in primary care.

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Section: Discussionsupporting

confidence: 93%

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

Barrecheguren

Monteagudo

Miravitlles

2018

npj Prim Care Resp Med

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“…[9], [10] Moreover, we confirm that pulmonary functional test was still underused, although the relative expense is low. [25], [26] On the other hand, performing spirometry may not be associated with significant improvement in the management of COPD. [27] Further studies are thus needed to investigate more closely the role of spirometry in the follow-up of COPD patients.…”

Section: Discussionmentioning

confidence: 99%

The Clinical and Economic Impact of Exacerbations of Chronic Obstructive Pulmonary Disease: A Cohort of Hospitalized Patients

et al. 2014

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BackgroundChronic Obstructive Pulmonary Disease (COPD) is a common disease with significant health and economic consequences. This study assesses the burden of COPD in the general population, and the influence of exacerbations (E-COPD) on disease progression and costs.MethodsThis is a secondary data analysis of healthcare administrative databases of the region of Lombardy, in northern Italy. The study included ≥ 40 year-old patients hospitalized for a severe E-COPD (index event) during 2006. Patients were classified in relation to the number and type of E-COPD experienced in a three-year pre-index period. Subjects were followed up until December 31st, 2009, collecting data on healthcare resource use and vital status.Results15857 patients were enrolled –9911 males, mean age: 76 years (SD 10). Over a mean follow-up time of 2.4 years (1.36), 81% of patients had at least one E-COPD with an annual rate of 3.2 exacerbations per person-year and an all-cause mortality of 47%. A history of exacerbation influenced the occurrence of new E-COPD and mortality after discharge for an E-COPD. On average, the healthcare system spent 6725€ per year per person (95%CI 6590–6863). Occurrence and type of exacerbations drove the direct healthcare cost. Less than one quarter of patients presented claims for pulmonary function tests.ConclusionsCOPD imposes a substantial burden on healthcare systems, mainly attributable to the type and occurrence of E-COPD, or in other words, to the exacerbator phenotypes. A more tailored approach to the management of COPD patients is required.

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“…However, its use in primary care centers is not widely achieved. In Spain, only half of the patients diagnosed with COPD in primary care had a spirometry, 12 which has also been identified in other countries like the USA in studies with more than 90,000 patients. 13 People with unrecognized COPD may miss the opportunity to improve their health status because of lack of performance of functional tests.…”

Section: Discussionmentioning

confidence: 82%

Differences in the use of spirometry between rural and urban primary care centers in Spain

Márquez-Martín¹,

Soriano²,

Rubio³

et al. 2015

COPD

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ObjectivesThe aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas.MethodsAn observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance.ResultsAlthough the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P<0.01). The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents.ConclusionThis study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these areas.

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Variabilidad en la realización de la espirometría y sus consecuencias en el tratamiento de la EPOC en Atención Primaria

Cited by 37 publications

References 25 publications

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

The Clinical and Economic Impact of Exacerbations of Chronic Obstructive Pulmonary Disease: A Cohort of Hospitalized Patients

Differences in the use of spirometry between rural and urban primary care centers in Spain

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