External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort)

Background: Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient''s lifestyle, social network and adherence to treatment. Methods: Design: External validation of scales, open and prospective cohort study in primary care. Setting: 36 health centres in 6 European high, medium and low income countries. Subjects: 477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse. Predictors: Detailed patient history, exacerbations, lung function test and questionnaires at baseline. Outcomes: Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment. Analysis: Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis. Discussion: The Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients. Trial registration:ISRCTN52402811. Date: 15/01/2015. Prospectively registered

Detección precoz de EPOC en las farmacias comunitarias de Baleares (FARBALEPOC)

Introducción: Importantes estudios como el EPISCAN ha puesto de manifiesto en España, el retraso diagnóstico de la EPOC y una elevada tasa de infradiagnóstico, encontrando que el 73% de los pacientes estaba sin diagnosticar y en la mayoría de los que se diagnosticaban ya se encontraban en estadios III y IV. Este retraso en el diagnóstico provoca una elevada morbilidad, así como un elevado coste asistencial. Por todo esto es necesario un diagnóstico precoz. Objetivos: Identificar pacientes de EPOC no diagnosticados, mediante un servicio de cribado de EPOC ofrecido por farmacias comunitarias. Material y métodos: Población de estudio: mayores de 40 años de ambos sexos, fumadores, exfumadores, y fumadores pasivos, que presentan signos o síntomas crónicos, y que en el cuestionario COPD-PS obtengan una puntuación ≥4. A los pacientes se les realizó la prueba de espiración forzada mediante el dispositivo portátil Vitalograph COPD-6. Si presentaba valores del cociente FEV1/FEV6 <0,75 se derivaba el paciente a su médico de familia para que se le realizase la espirometría convencional de confirmación. Resultados: Se encuestaron un total de 198 pacientes, 154 de ellos presentaban COPD-PS ≥4,38 (24,7%) de ellos presentaron resultados del cociente FEV1/FEV6 <0,75. La prevalencia de posible EPOC en este estudio se ha estimado en un 19,2% de los pacientes encuestados. Conclusiones: El significativo porcentaje de pacientes a los se les ha detectado una posible EPOC, nos demuestra la utilidad de implantar servicios de cribado y detección precoz de EPOC en las farmacias comunitarias