Variability in the Performing of Spirometry and Its Consequences in the Treatment of COPD in Primary Care

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

doi:10.1016/s1579-2129(11)70057-x

Cited by 24 publications

(20 citation statements)

References 24 publications

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“…7 Also in Spain, a study evaluated the performance of spirometry during 2 consecutive years in PC and showed that only 53.2% of patients with COPD had diagnostic spirometry results available, with a signifi cant variation observed in the percentage of diagnostic spirometries performed among different PC centers. 16 This variability has also been described in other countries. In the United States, a study of .…”

Section: Discussionsupporting

confidence: 62%

A Comprehensive, National Survey of Spirometry in Spain

Lόpez-Campos

Soriano²,

Calle

2013

Chest

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Section: Discussionsupporting

confidence: 62%

A Comprehensive, National Survey of Spirometry in Spain

Lόpez-Campos

Soriano²,

Calle

2013

Chest

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“…This low use of spirometry in primary care has been recognized in Spain10,12,13,19 and in other countries 20–22. This indicates that primary care physicians rely on other factors in order to make decisions about treatment.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Monteagudo¹,

Roset²,

Rodríguez-Blanco³

et al. 2017

COPD

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ObjectiveTo describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia.DesignWe performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. A descriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts.ResultsA total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0–8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months.ConclusionPatients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy.

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“…Despite the fact that the inclusion of coexistent diseases can greatly increase the complexity of the clinical guidelines, a fi rst attempt for an integrated approach to the disease was made recently (10). Moreover, discrepancies seen in COPD diagnosis and treatment observed in clinical practice, especially regarding the use of double bronchodilatation and/or inhaled corticosteroids (11)(12)(13), may be partly explained by the interplay between the presence of concomitant diseases other than COPD and factors such as lung functional assessment of the patients (11,14,15).…”

Section: Introductionmentioning

confidence: 99%

Moving Towards Patient-Centered Medicine for COPD Management: Multidimensional ApproachesversusPhenotype-Based Medicine—A Critical View

Lόpez-Campos

Bustamante

Muñoz³

et al. 2014

COPD: Journal of Chronic Obstructive Pulmonary Disease

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For decades, chronic obstructive pulmonary disease (COPD) has been considered a relentlessly progressive disease in which the deterioration of lung function is associated with an increase in symptoms, interrupted only by periods of exacerbation. However, this paradigm of COPD severity based on FEV1 has been challenged by currently available evidence. So far, three main approaches, though with contradictory aspects, have been proposed in order to address the complexity of COPD as well as to develop appropriate diagnostic, prognostic and therapeutic strategies for the disease: 1) the use of independent, clinically relevant variables, 2) the use of multidimensional indices, and 3) disease approaches based on clinical phenotypes. Multivariable systems seem superior to FEV1 in predicting prognosis and defining disease severity. However, selection of variables available from current literature must be confronted with issues of medical practice. Future evidence will be needed to reveal their effective relationship with disease long-term prognosis and to demonstrate the most adequate cutoff values to be used in clinical settings. Multidimensional scores provide a good prognostic instrument for the identification of patients with a particular degree of disease severity. Clinical phenotyping can help clinicians identify the patients who respond to specific pharmacological interventions; however, there is some controversy about the phenotypes to select and their long-term implications. Although these approaches are not perfect, they represent the first step towards patient-centered medicine for COPD. In the near-future, these different approaches should converge towards one new field to focus on the better management of COPD patients.

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Variability in the Performing of Spirometry and Its Consequences in the Treatment of COPD in Primary Care

Cited by 24 publications

References 24 publications

A Comprehensive, National Survey of Spirometry in Spain

A Comprehensive, National Survey of Spirometry in Spain

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Moving Towards Patient-Centered Medicine for COPD Management: Multidimensional ApproachesversusPhenotype-Based Medicine—A Critical View

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