Determinantes del infradiagnóstico de la enfermedad pulmonar obstructiva crónica

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad muy prevalente, que causa una gran morbimortalidad en el mundo y que es responsable de una importante carga económica y social. La Organización Mundial de la Salud (OMS) estimó en 1990 que 210 millones de personas padecían una EPOC (1). En España, el estudio EPISCAN, realizado en el 2007, mostró una prevalencia global de la EPOC del 10,2% (2). Una prevalencia que según el Global Burden of Disease Study (GBD) de 2010 ha ascendido, con un incremento que se ha estimado en un 1,1% (3). Este aumento en la prevalencia de la EPOC en nuestro medio depende fundamentalmente de dos factores: los efectos relacionados con la exposición tabáquica acumulada y el envejecimiento paulatino de la población. La EPOC es una enfermedad con un elevado impacto en salud pública, siendo motivo de numerosas consultas en atención primaria (más del 10% del total) y en el ámbito de la neumología (el 30% del total). Ocasiona, además, un elevado número de hospitalizaciones (10% de los ingresos por causa médica) y de fallecimientos (4). Actualmente representa la tercera causa de muerte en el mundo, situándose por detrás de la cardiopatía isquémica y del accidente cerebrovascular. La EPOC ascendió en el ranking mundial de mortalidad del cuarto puesto, en 1990, al tercero en 2010 (3). En España, la tasa de mortalidad por EPOC (muertes/por 100.000 habitantes), ajustada por población mundial fue, en el año 2008, de 449,22 en los hombres y 238,47 en las mujeres, con un aumento significativo de esta tasa a partir de los 55 años, sobre todo en los hombres. No obstante, pese a la elevada mortalidad de la EPOC, durante la última década se ha evidenciado una tendencia a disminuir, tanto en los hombres como en las mujeres, al comparar las tasas ajustadas por población mundial (5)..

Determinantes del infradiagnóstico de la enfermedad pulmonar obstructiva crónica

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 09-09-2015La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad muy prevalente, que causa una gran morbimortalidad en el mundo y que es responsable de una importante carga económica y social. La Organización Mundial de la Salud (OMS) estimó en 1990 que 210 millones de personas padecían una EPOC (1). En España, el estudio EPISCAN, realizado en el 2007, mostró una prevalencia global de la EPOC del 10,2% (2). Una prevalencia que según el Global Burden of Disease Study (GBD) de 2010 ha ascendido, con un incremento que se ha estimado en un 1,1% (3). Este aumento en la prevalencia de la EPOC en nuestro medio depende fundamentalmente de dos factores: los efectos relacionados con la exposición tabáquica acumulada y el envejecimiento paulatino de la población. La EPOC es una enfermedad con un elevado impacto en salud pública, siendo motivo de numerosas consultas en atención primaria (más del 10% del total) y en el ámbito de la neumología (el 30% del total). Ocasiona, además, un elevado número de hospitalizaciones (10% de los ingresos por causa médica) y de fallecimientos (4). Actualmente representa la tercera causa de muerte en el mundo, situándose por detrás de la cardiopatía isquémica y del accidente cerebrovascular. La EPOC ascendió en el ranking mundial de mortalidad del cuarto puesto, en 1990, al tercero en 2010 (3). En España, la tasa de mortalidad por EPOC (muertes/por 100.000 habitantes), ajustada por población mundial fue, en el año 2008, de 449,22 en los hombres y 238,47 en las mujeres, con un aumento significativo de esta tasa a partir de los 55 años, sobre todo en los hombres. No obstante, pese a la elevada mortalidad de la EPOC, durante la última década se ha evidenciado una tendencia a disminuir, tanto en los hombres como en las mujeres, al comparar las tasas ajustadas por población mundial (5)...The chronic obstructive pulmonary disease (COPD) is a highly prevalent disease and an important cause of worldwide morbidity and mortality which is responsible for a great economical and social burden. According to the World Health Organization (WHO), in 1990 some 210 million people worldwide suffered from COPD. In Spain, the EPI-SCAN survey conducted in 2007 revealed a global COPD prevalence of 10,2%. A prevalence which has increased an estimated 1,1% according to the Global Burden of Disease Study (GBD) of 2010. This increase in COPD prevalence in our country depends mainly on two factors: the cumulative exposure to tobacco smoke and the gradual aging of the population. COPD is an important public health issue and the reason for numerous primary care visits (more than 10% of their total number) and pulmonology visits (a 30% of total). Moreover, it causes a great number of hospital admissions (a 10% of medical admissions) and deaths. It is the third leading cause of death worldwide following ischemic heart disease and stroke. Nevertheless, despite all the data of COPD being a very prevalent disease with an important morbidity and mortality, we know that it is largely under-diagnosed. This is confirmed by IBERPOC study conducted in Spain in 1997, which revealed a high level of under-diagnosis since 78.2% of spirometrically confirmed COPD were newly diagnosed. These results have been reproduced 10 years later in the EPI-SCAN survey which showed that COPD under-diagnosis in Spain has been only slightly reduced, from 78% to 73%. Besides the important COPD under-diagnosis, theses studies also revealed that the disease is diagnosed in advanced stages when a great percentage of patient's lung function has been already lost. This reality obviates the need to improve the diagnosis of COPD with a straightforward goal: to be able to change it's natural history and reduce it's complications and associated morbidity and mortality. A correct and early diagnosis will influence the disease evolution and reduce it's morbidity and mortality...Depto. de MedicinaFac. de MedicinaTRUEunpu

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

Objectives: The 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. Methods: An 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. Results: Although 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. Conclusion: This 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 area

Determinants in the Underdiagnosis of COPD in Spain—CONOCEPOC Study

Respiratory symptoms; Spirometry; UnderdiagnosisSíntomas respiratorios; Espirometría; InfradiagnósticoSímptomes respiratoris; Espirometria; InfradiagnòsticFactors such as seeking medical attention for respiratory symptoms and health professionals ordering spirometry come into play in the underdiagnosis of chronic obstructive pulmonary disease (COPD). The objective of this study was to analyze seeking medical attention and the use of spirometry in individuals with chronic respiratory symptoms and to compare these results with those obtained in the 2005 and 2011 surveys. Material and Methods: A cross-sectional, observational, epidemiological study was conducted via phone interview in December 2020 in Spain, with a representative sample from 17 autonomous communities. The study design was identical to that of the studies carried out in 2005 and 2011 to evaluate the changes that have occurred in seeking medical attention and performing spirometry in Spain, as well as the variability between autonomous communities. Results: From 89,601 phone contacts, a total of 6534 respondents were obtained. A total of 24.8% reported having some chronic respiratory symptom, and 17.9% reported a respiratory disease. Only 51.6% of those who had some chronic respiratory symptom had seen their doctor, which was less likely among current smokers (OR: 0.599, 95% CI: 0.467–0.769, p < 0.001) and those living in a rural setting (OR: 0.797, 95% CI: 0.651–0.975, p = 0.027). A total of 68.7% of the individuals who saw a doctor reported having undergone spirometry, most frequently males (OR: 1.535, 95% CI: 2.074–1.136, p < 0.005), former smokers (OR: 1.696, 95% CI: 2.407–1.195, p < 0.003), and those seen by a pulmonologist (OR: 6.151, 95% CI: 8.869–4.265, p < 0.001). With respect to the 2005 survey, more frequent use of spirometry has been observed (42.6 vs. 68.7%), without any change in seeking medical attention for respiratory symptoms. There is a clear variability according to the autonomous community (p < 0.05). Conclusions: Many individuals with chronic respiratory symptoms do not seek medical attention and although the use of spirometry has increased in the past 15 years, it is still an important area that needs improving in the primary care setting, especially among women. Both of these factors can be determinants in the underdiagnosis of COPD and its variability between autonomous communities.This study has been promoted and sponsored by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). We thank GlaxoSmithKline Spain for its financial support in carrying out the study; grant number 214465. The financing entities did not participate in the design of the study, data collection, analysis, publication, or preparation of this manuscript

Smoking and COPD Knowledge in the General Spanish Population: A CONOCEPOC Study

Chronic obstructive pulmonary disease; Knowledge; Tobacco useMalaltia pulmonar obstructiva crònica; Coneixement; Consum de tabacEnfermedad pulmonar obstructiva crónica; Conocimiento; Consumo de tabacoBackground: The objective of this analysis is to evaluate tobacco use and the level of chronic obstructive pulmonary disease (COPD) knowledge among the general adult population in Spain and to compare these results to those obtained in the 2011 survey. Methods: A cross-sectional, observational, epidemiological study was conducted by telephone interviews and stratified by sex, age, and setting. The study design was identical to that of the study conducted in 2011. Results: Of a total of 89,601 phone contacts, there were 6534 respondents. The average age was 61.5 years. With respect to smoking, 30.9% reported being former smokers and 14.7% were current smokers, 63.6% of whom reported having attempted to quit. Among the current smokers, 19.7% claimed to use electronic cigarettes, although 88% believe these pose a health risk. No significant differences were found in smoking prevalence or frequency of attempts to quit according to residential setting (rural/urban). The highest prevalence of current smoking in men was recorded in the 55–64 years age range (31.6%), while in women it was from 45 to 54 years (34.6%). Smoking has decreased with respect to 2011, from 21.1% to 16.1% in men and from 17.9% to 13.2% in women, with a clear variability according to region. Of the population surveyed, 32.5% had spontaneous knowledge about COPD, with significant geographic variability. The most frequent sources of information about the disease were social media and the Internet (39.6%), followed by the media (35.2%). Conclusions: The prevalence of tobacco use in adults has considerably decreased and there is greater knowledge about COPD in Spain, although there is significant variability according to region, which could explain the geographic variability in the prevalence of COPD. Strategies are needed to increase COPD education and awareness and to reinforce smoking prevention measures among women.This study has been promoted and sponsored by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). We thank GlaxoSmithKline Spain for its financial support in carrying out the study (grant number 214465). The financing entities did not participate in the design of the study, data collection, analysis, publication, or preparation of this manuscript

Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study

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.SEPA

A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease; Exacerbations; Inhaled corticosteroidsMalaltia pulmonar obstructiva crònica; Empitjorament; Corticoesteroides inhalatsEnfermedad pulmonar obstructiva crónica; Empeoramiento; Corticoesteroides inhaladosAccording 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

Testing for Vitamin D in High-Risk COPD in Outpatient Clinics in Spain: A Cross-Sectional Analysis of the VITADEPOC Study

Background: Vitamin D deficiency has been associated with an accelerated deterioration in lung function and increased exacerbations in chronic obstructive pulmonary disease (COPD). 25(OH) vitamin D levels have been indicated as a potentially useful marker for adverse results related to COPD. Methods: VITADEPOC is a cross-sectional clinical study recruiting consecutive patients with high-risk COPD. The objective of our study was to investigate vitamin D determination frequency in patients with high-risk COPD in clinical practice at outpatient clinics in Spain and to describe the factors associated with vitamin D testing. We also aimed to determine the frequency of vitamin D deficiency in these patients. Results: Only 51 (44%) patients underwent vitamin D determination and 33 (28.4%) had received vitamin D supplements in clinical practice. The patients who underwent testing for vitamin D in clinical practice were more often women (58.8% vs. 26.2%, p < 0.001) with comorbidities such as osteoporosis (19.6% vs. 6.2%, p < 0.001) or chronic renal failure (7.8% vs. 0%, p < 0.001) and with exacerbator phenotype (55% vs. 32.3%, p = 0.015). A total of 63 (54.3%) patients had serum vitamin D levels <20 ng/mL at the inclusion visit. Of these, 29 (46%) had serum vitamin D levels <12 ng/mL (severe deficiency). Having a history of inhaled corticosteroids (OR 3.210, p < 0.016), being treated with a cycle of systemic corticosteroids (OR 2.149, p < 0.002), and having a lower physical activity level (OR 3.840, p < 0.004) showed a statistically significant positive association with vitamin D deficiency. Conclusion: The testing of vitamin D levels in patients with high-risk COPD treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, a severe deficiency is detected in one in four patients. Efforts to optimize case detection in COPD are needed.Depto. de MedicinaFac. de MedicinaTRUESociedad Madrileña de Neumología y Cirugía TorácicaResearch Pharma S.Lpu

A Process for Self-Training of Engineering Educators Using e-Learning

This article proposes an e-learning process for engineering educators involving a self-training approach. To develop the process, the researchers considered a set of entries to allow enrolled educators to engage in and successfully complete a training program without a lead instructor using an e-learning platform. In addition, the proposed process establishes a set of outputs that are the expected results and achievements that educators would be expected to obtain. In this study, educators play a double role: self-tutors and learners. As a case study, a Massive Open Online Course (MOOC) is used as a self-training program; the topic of the program is web accessibility. The use of this MOOC was proposed to a group of engineering educators. The case study shows how engineering educators can contribute to learning in society about web accessibility and its benefit to people, especially people with disabilities. Finally, the researchers present the advantages of using the proposed e-learning process, as well as its limitations

Distribution and Outcomes of a Phenotype- Based Approach to Guide COPD Management: Results from the CHAIN Cohort

Rationale The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphy- sema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). How- ever, little is known on the distribution and outcomes of the four suggested phenotypes. Objective We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes. Methods We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes. Results Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV 1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacer- bations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year. Conclusions There is an uneven distribution of COPD phenotypes in stable COPD patients, with signifi- cant differences in demographics, patient-centered outcomes and health care resources use