Subutilization of COPD guidelines in primary care: a pilot study.

SUMMARY: Despite the popularity of chronic obstructive pulmonary disease (COPD) guidelines, studies have reported important deficits among primary care physicians (PCPs) with respect to diagnosis and treatment of COPD; as a consequence, COPD remains underrecognized and undertreated. METHODS: This was a multicenter pilot study to assess prescribing practices for COPD by PCPs according to COPD guidelines. This was a 2-phase study: In phase 1, PCPs from 27 Mexican cities, referred patients for evaluation, including spirometry and in phase 2, PCPs from 10 of those same cities were asked to answer a questionnaire on COPD practice guidelines. RESULTS: A total of 2293 subjects were included in phase 1; 472 (20.6%) had a FEV1/FVC <70%. Only 39% of patients with 30% ≤ FEV1 < 50% and 22% with FEV1 <30% were receiving combination therapy (long-acting bronchodilator + inhaled steroid). In phase 2, we recruited 999 PCPs; 72.5% of them said that they had read a COPD guideline and 59.4% answered that they used one in their practice. When asked which guideline(s) they used, we had 86 different responses with GOLD (Global Initiative for Chronic Obstructive Lung Disease; 34.1%) being the most common, followed by GINA (Global Initiative for Asthma; 12.8%). When asked why they did not used a guideline, we got 33 different answers; "never read them" was the most frequent answer (41.8%) followed by "lack of access to them" (18.2%) and "not enough time to read them" (6.0%). CONCLUSION: Despite the existence and availability of evidence-based guidelines, only a minority of primary health care COPD patients in Mexico are receiving state-of-the-art treatment at the primary care level.

Gran altitud y prevalencia de la enfermedad pulmonar obstructiva crónica: ¿relación casual o causal? / High Altitude and Chronic Obstructive Pulmonary Disease Prevalence: A Casual or Causal Correlation?

Introducción: Los estudios sobre la relación entre la prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) y la altitud han presentado resultados contradictorios. El objetivo de este estudio de identificación de casos de EPOC fue incluir un número elevado de localizaciones geográficas para determinar si hay una asociación entre la altitud y la prevalencia de la EPOC. Pacientes y métodos: Los pacientes de edad igual o superior a 40 años con factores de riesgo conocidos para la EPOC, sintomáticos o no, fueron remitidos por los médicos con quienes tenían el primer contacto. Tras obtener un consentimiento informado por escrito, se les invitó a responder a un cuestionario y se les realizó una espirometría previa y posterior a la administración de broncodilatador. Resultados: Los participantes fueron reclutados en 27 ciudades de México, con un rango de altitudes que iba de 1 a 2.680m sobre el nivel del mar. Observamos una correlación negativa débil (-0,31; p<0,0001) aunque significativa entre la altitud y la prevalencia de la EPOC. La tasa de EPOC en las ciudades situadas a ≤1.000m fue del 32,7%, frente al 16,4% observado en las ciudades situadas a >1.000m (p<0,0001); la tasa observada en las ciudades situadas a ≤2.000m fue del 22,7%, frente al 15,6% de las situadas a >2.000m; en el análisis de regresión logística múltiple, la edad creciente, el sexo masculino, el haber fumado en algún momento, los paquetes-años de tabaquismo, los años de exposición al humo de la biomasa y la altitud de la ciudad sobre el nivel del mar mostraron una asociación significativa con la prevalencia de la EPOC. Conclusiones: Nuestros datos muestran una correlación inversa significativa entre la prevalencia/gravedad de la EPOC y la altitud(AU)

Introduction: Studies on the relationship of chronic obstructive pulmonary disease (COPD) prevalence and altitude have reported contrasting results. The aim of this COPD case-finding study was to include a larger number of geographical sites to determine if there is an association between altitude and COPD prevalence. Patients and methods: Individuals aged 40 or older with known COPD risk factors, whether symptomatic or not, were referred by primary-care physicians. After obtaining written informed consent, they were invited to answer a questionnaire and undergo pre- and post-bronchodilator spirometry. Results: Subjects were recruited in 27 Mexican cities, within an altitude range from 1 to 2,680m above sea level. We found a weak (-0.31; P<.0001) although significant negative correlation between altitude and COPD prevalence. The COPD rate for cities located ≤1,000m was 32.7% vs 16.4% for cities located >1,000m (P<.0001); the rate for cities located at ≤2,000m was 22.7% vs 15.6% for those >2,000m; in the multiple logistic regression analysis, older age, male sex, tobacco habit, pack-years of smoking, years of exposure to biomass smoke and city altitude over sea level were significantly associated with COPD prevalence. Conclusions: Our data shows a significant inverse correlation between prevalence/severity of COPD and altitude(AU)

High altitude and chronic obstructive pulmonary disease prevalence: a casual or causal correlation?

INTRODUCTION: Studies on the relationship of chronic obstructive pulmonary disease (COPD) prevalence and altitude have reported contrasting results. The aim of this COPD case-finding study was to include a larger number of geographical sites to determine if there is an association between altitude and COPD prevalence. PATIENTS AND METHODS: Individuals aged 40 or older with known COPD risk factors, whether symptomatic or not, were referred by primary-care physicians. After obtaining written informed consent, they were invited to answer a questionnaire and undergo pre- and post-bronchodilator spirometry. RESULTS: Subjects were recruited in 27 Mexican cities, within an altitude range from 1 to 2,680 m above sea level. We found a weak (-0.31; P<.0001) although significant negative correlation between altitude and COPD prevalence. The COPD rate for cities located ≤1,000 m was 32.7% vs 16.4% for cities located >1,000 m (P<.0001); the rate for cities located at ≤2,000 m was 22.7% vs 15.6% for those >2,000 m; in the multiple logistic regression analysis, older age, male sex, tobacco habit, pack-years of smoking, years of exposure to biomass smoke and city altitude over sea level were significantly associated with COPD prevalence. CONCLUSIONS: Our data shows a significant inverse correlation between prevalence/severity of COPD and altitude.