COPD patient profiles in primary care. Referral criteria.

COPD is a disease with a high prevalence that diminishes the quality of life of many patients. Despite this, there are still high rates of under-diagnosis in Spain, partly due to a lack of recognition of the pathology by patients. In this context, the role played by primary care teams becomes fundamental, as they are one of the first lines of entry into the health system. In this paper we explain the different COPD profiles that may be present, and update the tools for diagnosis and treatment, which, together with an attitude of active suspicion of the disease, can help in the correct management of patients, whether they are undiagnosed or have subsequent complications.

Proyecto INCLIASMA fase II - Inercia clínica en asma en España / INCLIASMA phase II project – Clinical inertia in asthma in Spain

Objetivos El 80% de los pacientes con asma están mal controlados. A pesar de disponer de guías de práctica clínica (GPC) actualizadas, se sigue detectando un deficiente control y tratamiento del asma. El objetivo principal del estudio INCLIASMA faseII (INercia CLInica en ASMA) es analizar la realidad en el manejo del asma en las consultas de atención primaria (AP) españolas. Como objetivo secundario se planteó establecer una serie de recomendaciones clave en el manejo del paciente con asma, basadas en las conclusiones de los panelistas. Material y métodos Estudio transversal descriptivo, multicéntrico y no aleatorizado, que se desarrolló en dos rondas, siguiendo la metodología Delphi. Se elaboró un cuestionario on line específico para el proyecto de 41 ítems y divido en 5 bloques (diagnóstico, control, adherencia, tratamiento y criterios de derivación) y se pidió a un grupo de médicos de AP expertos en asma que expresaran su nivel de acuerdo o desacuerdo con el conjunto de ítems del cuestionario. De los resultados se identificaron las principales controversias existentes en el manejo de asma en España y se elaboraron recomendaciones prácticas. Resultados Participaron 24 panelistas. Hubo un consenso final en el 92,68% (38/41) de la totalidad de los ítems recogidos en el cuestionario. Los panelistas concluyeron que se tarda en exceso en diagnosticar el asma, existiendo un porcentaje elevado de pacientes asmáticos sin un correcto tratamiento, y, por ende, sin un adecuado control. La falta de tiempo, la sobrecarga asistencial o la inercia terapéutica son algunos de los factores determinantes de esta situación. Conclusione El estudio INCLIASMA faseII pone de relieve las controversias encontradas en la práctica clínica habitual en el manejo del asma, poniendo de manifiesto la necesidad continuada de formación y ofreciendo recomendaciones consensuadas que buscan mejorar el manejo de asma en nuestro país (AU)

Objectives Eighty percent of patients with asthma are poorly controlled. Despite the availability of updated clinical practice guidelines, poor asthma control and treatment continue to be detected. The main objective of the INCLIASMA phaseII study (INercia CLInica en ASMA) is to analyze the reality of asthma management in Spanish primary care (PC) clinics. As a secondary objective, it was proposed to establish a series of key recommendations in the management of patients with asthma, based on the conclusions of the panelists. Material and methods Cross-sectional descriptive, multicenter and non-randomized study, which was developed in two rounds, following the Delphi methodology. A specific online questionnaire was developed for the project with 41 items and divided into 5 blocks (diagnosis, control, adherence, treatment and referral criteria) and a group of PC physicians who were experts in asthma were asked to express their level of agreement or disagreement with the set of items in the questionnaire. From the results, the main existing controversies in the management of asthma in Spain were identified and practical recommendations were elaborated. Results Twenty-four panelists participated. There was a final consensus in 92.68% (38/41) of all the items collected in the questionnaire. The panelists concluded that it takes too long to diagnose asthma, and there is a high percentage of asthmatic patients without proper treatment, and therefore, without adequate control. Lack of time, care overload or therapeutic inertia are some of the determining factors in this situation. Conclusions The INCLIASMA phaseII study highlights the controversies found in routine clinical practice in asthma management, highlighting the continued need for training and offering consensus recommendations that seek to improve asthma management in our country (AU)

[INCLIASMA phase II project - Clinical inertia in asthma in Spain]. / Proyecto INCLIASMA fase II - Inercia clínica en asma en España.

OBJECTIVES: Eighty percent of patients with asthma are poorly controlled. Despite the availability of updated clinical practice guidelines, poor asthma control and treatment continue to be detected. The main objective of the INCLIASMA phaseII study (INercia CLInica en ASMA) is to analyze the reality of asthma management in Spanish primary care (PC) clinics. As a secondary objective, it was proposed to establish a series of key recommendations in the management of patients with asthma, based on the conclusions of the panelists. MATERIAL AND METHODS: Cross-sectional descriptive, multicenter and non-randomized study, which was developed in two rounds, following the Delphi methodology. A specific online questionnaire was developed for the project with 41 items and divided into 5 blocks (diagnosis, control, adherence, treatment and referral criteria) and a group of PC physicians who were experts in asthma were asked to express their level of agreement or disagreement with the set of items in the questionnaire. From the results, the main existing controversies in the management of asthma in Spain were identified and practical recommendations were elaborated. RESULTS: Twenty-four panelists participated. There was a final consensus in 92.68% (38/41) of all the items collected in the questionnaire. The panelists concluded that it takes too long to diagnose asthma, and there is a high percentage of asthmatic patients without proper treatment, and therefore, without adequate control. Lack of time, care overload or therapeutic inertia are some of the determining factors in this situation. CONCLUSIONS: The INCLIASMA phaseII study highlights the controversies found in routine clinical practice in asthma management, highlighting the continued need for training and offering consensus recommendations that seek to improve asthma management in our country.

Proyecto INCLIASMA - inercia clínica en asma / INCLIASMA project – Clinical inertia in asthma

Objetivos: El asma es una enfermedad de alta prevalencia que limita la calidad de vida de los pacientes y tiene elevados costes sanitarios. A pesar de disponer de guías de práctica clínica, se sigue detectando un deficiente control del asma. El objetivo de este proyecto es estudiar el manejo del asma desde las consultas de atención primaria de Aragón, España. Material y métodos: Estudio cualitativo, multicéntrico y no aleatorizado, que se desarrolló en dos rondas, siguiendo la metodología Delphi. Se pidió a un grupo de médicos de Atención Primaria con amplia experiencia en el manejo del asma que expresaran su nivel de acuerdo con el conjunto de ítems del cuestionario propuesto por el comité científico del proyecto. El cuestionario de 28 ítems se estructuró en cuatro bloques: diagnóstico, control, adherencia y tratamiento. Resultados: El cuestionario fue respondido por 15 panelistas. Hubo consenso en el 82,14% (23/28) de los ítems. Se encontraron dificultades para diagnosticar el asma de forma precoz y certera. Existe una confusión entre control y gravedad. La percepción de adherencia es muy variable. Hay un sobreuso de broncodilatadores de acción corta. Se evidencia mucha inercia terapéutica. Conclusiones: El estudio Inercia Clínica en Asma (INCLIASMA) pone de relieve las controversias encontradas entre lo que aconsejan las guías de práctica clínica y la evidencia real y ofrece recomendaciones para subsanar las diferencias encontradas (AU)

Objectives: Asthma is a highly prevalent disease limiting the quality of life of patients and has high health costs. Despite having clinical practice guidelines, poor asthma control continues to be detected. The objective of this project is to study asthma management from primary care consultations in Aragón, Spain. Material and methods: Qualitative, multicenter and non-randomized study, developed in two-round, following Delphi methodology. A group of a group of Primary Care physicians with extensive experience in asthma management were asked to express their level of agreement with the set of items of the questionnaire proposed by the scientific committee of the project. The 28-item survey was structured in 4 blocks: diagnosis, control, adherence and treatment. Results: The survey was answered by 15 experts. Consensus was reached in 82.14% (23/28) of the items. Difficulties were found in diagnosing asthma early and accurately. There is a confusion between control and severity. The perception of adherence is highly variable. There is an overuse of short-acting bronchodilators. Much therapeutic inertia is evidenced. Conclusions: The INCLIASMA study highlights the existing controversies between what is advised in the guidelines of clinical practice and the real evidence and provides recommendations to correct the differences found (AU)

[INCLIASMA project - Clinical inertia in asthma]. / Proyecto INCLIASMA - inercia clínica en asma.

OBJECTIVES: Asthma is a highly prevalent disease limiting the quality of life of patients and has high health costs. Despite having clinical practice guidelines, poor asthma control continues to be detected. The objective of this project is to study asthma management from primary care consultations in Aragón, Spain. MATERIAL AND METHODS: Qualitative, multicenter and non-randomized study, developed in two-round, following Delphi methodology. A group of a group of Primary Care physicians with extensive experience in asthma management were asked to express their level of agreement with the set of items of the questionnaire proposed by the scientific committee of the project. The 28-item survey was structured in 4 blocks: diagnosis, control, adherence and treatment. RESULTS: The survey was answered by 15 experts. Consensus was reached in 82.14% (23/28) of the items. Difficulties were found in diagnosing asthma early and accurately. There is a confusion between control and severity. The perception of adherence is highly variable. There is an overuse of short-acting bronchodilators. Much therapeutic inertia is evidenced. CONCLUSIONS: The INCLIASMA study highlights the existing controversies between what is advised in the guidelines of clinical practice and the real evidence and provides recommendations to correct the differences found.

Fármacos potencialmente útiles en el tratamiento de la COVID-19 en Atención Primaria / Potentially useful drugs in the treatment of COVID-19 in Primary Care

Las consecuencias de la pandemia por el SARS-CoV-2 han desbordado cualquier previsión realizada. Hoy sabemos que el nivel de gravedad de la infección en sus fases iniciales se va a corresponder con la evolución y la presencia de secuelas en el futuro. No existen tratamientos específicos que hayan demostrado evidencia suficiente que permita su recomendación, especialmente en las fases leves-moderadas de la enfermedad. La vacunación anti-COVID está demostrando claros beneficios, tanto en la prevención de la enfermedad como en la evolución de la misma, con la consiguiente mejoría en las cifras de afectados por la pandemia. A pesar de ello, el número de nuevos contagios persiste en cifras inaceptables. Se ha propuesto el uso de distintos fármacos utilizados en otras indicaciones como posibles tratamientos beneficiosos para la COVID-19 que, en caso de utilizarse, se prescribirán de forma individualizada atendiendo a las características y la situación del paciente, a la fase evolutiva de la enfermedad, así como a las limitaciones propias de la falta de evidencia en su administración (AU)

The consequences of the SARS-CoV-2 pandemic have exceeded any forecast made. Today we know that the level of severity of the infection in its initial stages will correspond to the evolution and the presence of sequelae in the future. There are no specific treatments that have shown sufficient evidence to allow their recommendation, especially in the mild-moderate stages of the disease. The anti-Covid vaccination is showing clear benefits, both in the prevention of the disease and in its evolution, with the consequent improvement in the numbers of those affected by the pandemic. The use of different drugs used in other indications has been proposed as possible beneficial treatments for COVID-19 that, if used, will be prescribed individually taking into account the characteristics and situation of the patient, the evolutionary phase of the disease as well as well as the limitations of the lack of evidence in its administration (AU)

Pulsioximetría: papel en el paciente COVID-19 domiciliario / Pulse oximetry: Role in the COVID-19 patient at home

La COVID-19 se comporta como una enfermedad heterogénea. Algunos pacientes pueden presentar hipoxemia sin disnea durante su evolución (hipoxemia silente). La pulsioximetría juega un papel crucial en la detección de la hipoxemia en estos pacientes, especialmente cuando permanecen en su domicilio. Pacientes con niveles de SpO2 ≤ 92% o desaturaciónes ≥ 3% tras el ejercicio precisan de ingreso hospitalario. Los descensos progresivos de la saturación que alcancen niveles SpO2 < 96% precisan de valoración clínica estricta (estudio radiológico, analítica sanguínea) para lo que será enviado a un centro sanitario (AU)

COVID-19 behaves like a heterogeneous disease. Some patients may develop dyspnea-free hypoxemia during its evolution (silent hypoxemia). Pulse oximetry plays a crucial role in detecting hypoxemia in these patients, especially when they remain at home. Patients with SpO2 levels ≤ 92% or desaturations ≥ 3% after exercise test require hospital admission. Progressive saturation declines reaching SpO2 levels < 96% require strict clinical assessment (radiological study, blood test) for which it will be sent to a health center (AU)

[Pulse oximetry: Role in the COVID-19 patient at home]. / Pulsioximetría: papel en el paciente COVID-19 domiciliario.

COVID-19 behaves like a heterogeneous disease. Some patients may develop dyspnea-free hypoxemia during its evolution (silent hypoxemia). Pulse oximetry plays a crucial role in detecting hypoxemia in these patients, especially when they remain at home. Patients with SpO2 levels ≤ 92% or desaturations ≥ 3% after exercise test require hospital admission. Progressive saturation declines reaching SpO2 levels < 96% require strict clinical assessment (radiological study, blood test) for which it will be sent to a health center.

[Potentially useful drugs in the treatment of COVID-19 in Primary Care]. / Fármacos potencialmente útiles en el tratamiento de la COVID-19 en Atención Primaria.

The consequences of the SARS-CoV-2 pandemic have exceeded any forecast made. Today we know that the level of severity of the infection in its initial stages will correspond to the evolution and the presence of sequelae in the future. There are no specific treatments that have shown sufficient evidence to allow their recommendation, especially in the mild-moderate stages of the disease. The anti-Covid vaccination is showing clear benefits, both in the prevention of the disease and in its evolution, with the consequent improvement in the numbers of those affected by the pandemic. The use of different drugs used in other indications has been proposed as possible beneficial treatments for COVID-19 that, if used, will be prescribed individually taking into account the characteristics and situation of the patient, the evolutionary phase of the disease as well as well as the limitations of the lack of evidence in its administration.

Diabetes mellitus en el anciano / Diabetes mellitus in the elderly

No disponible

Actualización en el tratamiento farmacológico del dolor neuropático / Update in the pharmacological treatment of neuropathic pain

Ofrecemos una revisión actualizada del tratamiento farmacológico del dolor neuropático con énfasis en las últimas recomendaciones basadas en la evidencia disponible. Los medicamentos propuestos como primera línea incluyen antidepresivos tricíclicos (particularmente amitriptilina), inhibidores de la recaptación de serotonina y noradrenalina (particularmente duloxetina), pregabalina y gabapentina. Los tratamientos de segunda línea comprenden los apósitos de lidocaína al 5% y parches de capsaicina al 8%, solamente para el dolor neuropático periférico, y el tramadol; mientras que los opioides potentes y la toxina botulínica A (para el dolor neuropático periférico) se consideran tratamientos de tercera línea. Futuras perspectivas engloban el desarrollo de nuevos fármacos y un abordaje terapéutico con un enfoque más personalizado, que es posible gracias a los recientes avances en la evaluación y comprensión del dolor neuropático

We provide an updated review of the pharmacological treatment of neuropathic pain, with emphasis on the latest evidence-based recommendations. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-noradrenaline reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second-line treatments include 5% lidocaine medicated plasters and capsaicin 8% patches, only for peripheral neuropathic pain and tramadol; whereas potent opioids and botulinum toxin A (for peripheral neuropathic pain) are considered third-line treatments. Future perspectives include the development of new drugs and a more personalised therapeutic approach, which is made possible by recent progress in the assessment and understanding of neuropathic pain

[Update in the pharmacological treatment of neuropathic pain]. / Actualización en el tratamiento farmacológico del dolor neuropático.

We provide an updated review of the pharmacological treatment of neuropathic pain, with emphasis on the latest evidence-based recommendations. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-noradrenaline reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second-line treatments include 5% lidocaine medicated plasters and capsaicin 8% patches, only for peripheral neuropathic pain and tramadol; whereas potent opioids and botulinum toxin A (for peripheral neuropathic pain) are considered third-line treatments. Future perspectives include the development of new drugs and a more personalised therapeutic approach, which is made possible by recent progress in the assessment and understanding of neuropathic pain.

Hospitalización domiciliaria: el hospital en casa / Home care services: hospital at home

No disponible