Riesgos, fenotipos y comparación de tratamiento de EPOC en atención primaria según guías GOLD y GesEPOC / Risks, phenotypes and comparison between treatments according to guidelines GOLD and GesEPOC in primary care

Introducción La enfermedad pulmonar obstructiva crónica (EPOC) es una patología infradiagnosticada, con una elevada morbimortalidad. El diagnóstico y el seguimiento se realizan en gran parte en atención primaria (AP). El objetivo de nuestro estudio es clasificar los pacientes EPOC de acuerdo con GOLD 2019 y GesEPOC 2017. Como objetivos secundarios, analizar el tipo de riesgo, describir y comparar el tratamiento pautado con el recomendado por las guías. Material y métodos Estudio observacional transversal multicéntrico realizado en siete equipos de AP. Se incluyeron 637 pacientes EPOC entre 35 y 85años. Resultado La edad media fue de 70,3años, el 84,6% tenían comorbilidades y el 43,5% eran fumadores activos. El FEV1 post-broncodilatador medio fue del 61,92% (DE: 17,42). Predominaron los pacientes con mMRC=1 (43,8%), 57,8% CAT<10. Índice BODEx leve (75,7%). GoldA fue mayoritario (47,7%). El fenotipo más frecuente fue el no agudizador (61,1%). El 25% fueron ACO. El 56,2% eran pacientes de bajo riesgo. El 20,6% no tenían prescrito ningún tratamiento, LABA +LAMA +CI (19,6%), LAMA +LABA (16,5%) y LAMA (16,3%). Si comparamos los tratamientos que tienen pautados los pacientes con lo que recomienda la GOLD, obtenemos que el 61% coinciden con una concordancia moderada, mientras que si los comparamos con la GesEPOC, el 53,8% coinciden con concordancia débil. El 73,4% de los tratamientos coinciden entre ambos documentos (concordancia moderada). Conclusiones Los pacientes EPOC atendidos en AP son de bajo riesgo, leves y no agudizadores. Si comparamos los tratamientos que tienen pautados los pacientes con lo que recomiendan la GOLD y la GesEPOC, encontramos una concordancia moderada y débil, respectivamente (AU)

Introduction Chronic obstructive pulmonary disease (COPD) is an underdiagnosed pathology with a high morbidity and mortality. Diagnosis and follow-up are mostly carried out in primary care (PC). The objective of our study is to classify COPD patients according to GOLD 2019 and GesEPOC 2017 guidelines. As secondary objectives, to analyze the type of risk and to describe and compare the prescribed treatment with that recommended by the guidelines. Material and methods Multicenter cross-sectional observational study in seven Health Care centers. 637 COPD patients between 35 and 85years old were included. Results The mean age was 70.3years old, 84.6% had comorbidities and 43.5% were active smokers. The mean post-bronchodilator FEV1 was 61.92% (SD: 17.42). Most are patients with mMRC=1 (43.8%), 57.8% CAT<10. Mild BODEx index (75.7%). GoldA was the majority (47.7%). The most frequent phenotype was non-exacerbator (61.1%). 25% were ACOs. 56.2% were low-risk patients. 20.6% had not been prescribed any treatment, LABA +LAMA +CI (19.6%), LAMA +LABA (16.5%) and LAMA (16.3%). If we compare the treatments that the patients have prescribed, with the one is recommended by GOLD, we obtain that 61% coincide with moderate concordance, while if we compare with GesEPOC, 53.8% coincide with weak concordance. 73.4% of the treatments coincide between both documents (moderate agreement). Conclusions COPD patients treated in PC are low risk, mild and non-exacerbators. If we compare the treatments that the patients have prescribed, with what is recommended by GOLD and GesEPOC, we find a moderate and weak concordance, respectively (AU)

[Risks, phenotypes and comparison between treatments according to guidelines GOLD and GesEPOC in primary care]. / Riesgos, fenotipos y comparación de tratamiento de EPOC en atención primaria según guías GOLD y GesEPOC.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is an underdiagnosed pathology with a high morbidity and mortality. Diagnosis and follow-up are mostly carried out in primary care (PC). The objective of our study is to classify COPD patients according to GOLD 2019 and GesEPOC 2017 guidelines. As secondary objectives, to analyze the type of risk and to describe and compare the prescribed treatment with that recommended by the guidelines. MATERIAL AND METHODS: Multicenter cross-sectional observational study in seven Health Care centers. 637 COPD patients between 35 and 85years old were included. RESULTS: The mean age was 70.3years old, 84.6% had comorbidities and 43.5% were active smokers. The mean post-bronchodilator FEV1 was 61.92% (SD: 17.42). Most are patients with mMRC=1 (43.8%), 57.8% CAT<10. Mild BODEx index (75.7%). GoldA was the majority (47.7%). The most frequent phenotype was non-exacerbator (61.1%). 25% were ACOs. 56.2% were low-risk patients. 20.6% had not been prescribed any treatment, LABA +LAMA +CI (19.6%), LAMA +LABA (16.5%) and LAMA (16.3%). If we compare the treatments that the patients have prescribed, with the one is recommended by GOLD, we obtain that 61% coincide with moderate concordance, while if we compare with GesEPOC, 53.8% coincide with weak concordance. 73.4% of the treatments coincide between both documents (moderate agreement). CONCLUSIONS: COPD patients treated in PC are low risk, mild and non-exacerbators. If we compare the treatments that the patients have prescribed, with what is recommended by GOLD and GesEPOC, we find a moderate and weak concordance, respectively.

Calidad de vida y factores asociados en asmáticos de un centro de Atención Primaria. Aplicación de la versión reducida del Asthma Quality of Life Questionnaire / Quality of life and associated factors in asthma in a Primary Care Center. Application of the reduced version of the Asthma Quality of Life Questionnaire

Introducción. El asma es una enfermedad de elevada prevalencia y que puede afectar a la calidad de vida (CV). Nuestro objetivo ha sido conocer la CV en pacientes con asma y su relación con diferentes variables en un centro de Atención Primaria. Material y métodos. Estudio descriptivo transversal, realizado en un centro de salud urbano. Se seleccionaron 243 pacientes de entre 17-70 años en los que constaba el diagnóstico de asma en su historia clínica. La CV se estudió mediante la versión española reducida del Asthma Quality of Life Questionnaire, analizándose como variables asociadas la edad, el sexo, el tabaquismo, la ansiedad, la depresión, la gravedad y el control del asma. Resultados. La edad media fue de 44,5 años, con un 71,2% de mujeres. El 54,3% tenían asma intermitente y el 45,7% asma persistente. La puntuación global del Mini-Asthma Quality of Life Questionnaire fue de 5,4 sobre 7. Por dimensiones fueron las siguientes: síntomas 5,4; limitación de actividades 5,8; función emocional 5,7; estímulos ambientales 4,7. Las variables con peor puntación de CV que mantuvieron la significación estadística (p<0,05) en el análisis multivariado fueron el peor control del asma (en todas las dimensiones), el antecedente de depresión (en todas excepto estímulos ambientales), los estudios inferiores a secundarios (síntomas y función emocional) y los pacientes con ingresos hospitalarios los últimos 3 años (síntomas) y que utilizaron betaadrenérgicos de larga duración (función emocional). Conclusiones. Los pacientes con asma intermitente, persistente leve y moderada tenían una buena CV. El peor control del asma y el antecedente de depresión afectaron negativamente sobre la CV (AU)

Introduction. Asthma is a highly prevalent disease that can affect the quality of life (QoL). The objective of this study is to determine the QoL in patients with asthma and its relationship with different factors in a Primary Care centre. Material and methods. A descriptive, cross-sectional study was conducted in an urban health centre. The study included a total of 243 patients between 17 to 70 years who had a diagnosis of asthma in their medical records. The QoL was measured using the Spanish version of the Mini-Asthma Quality of Life Questionnaire, with age, sex, smoking, anxiety, depression, severity and control of asthma as associated variables. Results. The mean age was 44.5 years and 71.2% were women. More than half (54.3%) had intermittent asthma, and 45.7% persistent asthma. The overall score in the Mini-Asthma Quality of Life Questionnaire was 5.4 out of 7. The scores by dimensions were: symptoms 5.4; limitation of activities 5.8; emotional function 5.7, and environmental stimuli 4.7. The variables with a worse QoL score that remained statistically significant (P<.05) in the multivariate analysis were poor control of asthma (in all dimensions), history of depression (in all except environmental stimuli), educated to less than secondary level (symptoms and emotional function), and patients admitted to hospital in the past 3 years (symptoms) and who used long-term beta-adrenergics (emotional function). Conclusions. Patients with intermittent, mild and moderate asthma have a good QoL. Poor control of the asthma and a history of depression negatively affect the QoL (AU)

[Quality of life and associated factors in asthma in a Primary Care Center. Application of the reduced version of the Asthma Quality of Life Questionnaire]. / Calidad de vida y factores asociados en asmáticos de un centro de Atención Primaria. Aplicación de la versión reducida del Asthma Quality of Life Questionnaire.

INTRODUCTION: Asthma is a highly prevalent disease that can affect the quality of life (QoL). The objective of this study is to determine the QoL in patients with asthma and its relationship with different factors in a Primary Care centre. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in an urban health centre. The study included a total of 243 patients between 17 to 70 years who had a diagnosis of asthma in their medical records. The QoL was measured using the Spanish version of the Mini-Asthma Quality of Life Questionnaire, with age, sex, smoking, anxiety, depression, severity and control of asthma as associated variables. RESULTS: The mean age was 44.5 years and 71.2% were women. More than half (54.3%) had intermittent asthma, and 45.7% persistent asthma. The overall score in the Mini-Asthma Quality of Life Questionnaire was 5.4 out of 7. The scores by dimensions were: symptoms 5.4; limitation of activities 5.8; emotional function 5.7, and environmental stimuli 4.7. The variables with a worse QoL score that remained statistically significant (P<.05) in the multivariate analysis were poor control of asthma (in all dimensions), history of depression (in all except environmental stimuli), educated to less than secondary level (symptoms and emotional function), and patients admitted to hospital in the past 3 years (symptoms) and who used long-term beta-adrenergics (emotional function). CONCLUSIONS: Patients with intermittent, mild and moderate asthma have a good QoL. Poor control of the asthma and a history of depression negatively affect the QoL.

[Do we forget asthma as a chronic illness in our primary care consultations?]. / 'Olvidamos el asma como enfermedad crónica en nuestras consultas de atención primaria?

OBJECTIVE: To describe the characteristics of the asthmatic population at our centre through the information gathered from clinical records, the morbidity caused by asthma and the health education given. DESIGN: Retrospective, descriptive study. SETTING: Urban primary care team. PARTICIPANTS: Asthma sufferers over 14 registered at the centre (n=284). MAIN MEASUREMENTS: Review of the clinical records and analysis of data on diagnosis, follow-up and control of the illness. RESULTS: Prevalence of asthmatics at our centre ran at 1.8%. 73.6% (68.5-78.7) were women, whose average age was 51.25 (21.57). 19% were illiterate. The most common kind of asthma was intermittent (14.1%, 10-18.1). Respiratory infections sparked off acute attacks in 15% (11.3-19.7) of cases. 39.8% (31.4-45.5) (n=113) were diagnosed at the health centre. Spirometry was used as a diagnostic test in 23% (15.2-30.8) (n=26) of these 113 patients. The PC doctor participated in monitoring 81.7% (77.2-86.2) of asthma cases. Spirometry was used in the previous 3 years on 45.4% (39.6-51.2). 95% of spirometry tests were conducted at the hospital. As to health education, there was no record of explanations about the concept of asthma or of breathing techniques in 90.1% (86.1-93.4) and 81% (76.4-85.5) of clinical records, respectively. CONCLUSIONS: High percentage of asthmatics monitored by PC doctors. Under-recording in clinical records of asthma-related action taken. Few additional monitoring tests were conducted. There were few data on health education.

[Do our asthma patients still use inhalers incorrectly?]. / Siguen utilizando incorrectamente los inhaladores nuestros pacientes asmáticos?

AIM: To determine how skilled our patients with asthma are in performing different steps in the use of different inhalation devices, and to identify variables that may influence correct inhalation technique (IT). DESIGN: Descriptive, cross-sectional study. SETTING: An urban primary care center. PARTICIPANTS: 141 patients with asthma. MAIN OUTCOME MEASURES: Performance of a practical test to evaluate each step in IT for different devices according to SEPAR-semFYC guidelines. One point was scored for each step that was performed correctly, and the technique was considered correct if the total score was >9. The main outcome variable was the percentage of patients who performed the IT correctly. RESULTS: About three-fourths of the participants (77.3%) were women; mean age was 56.08 +/- 18.99 years. Inhalation technique was incorrect in 53.9% of the patients (51.06% of those who used a pressurized canister inhaler, 59.1% of those who used a PCI+spacer, 38.5% of those who used a Turbuhaler, and 37.5% of those who used an Accuhaler). The highest error rates were seen in exhaling completely before beginning the inhalation (63.78%), holding the breath after inhalation for as long as possible (65.94%), and breathing out slowly after the inhalation (64.86%). Better IT was seen in younger patients with higher levels of education (P=.007). There were no statistically significant differences in the rest of the variables. CONCLUSIONS: A large percentage of patients performed inhalations incorrectly. We cannot conclude that any given device is superior. The variables related with correct IT were age and level of education. Greater health education efforts are needed to teach patients how to use inhalation systems correctly.

¿Siguen utilizando incorrectamente los inhaladores nuestros pacientes asmáticos? / Do our asthma patients still use inhalers incorrectly?

Objetivo. Conocer la destreza de nuestros pacientes asmáticos en la realización de las maniobras de los diferentes sistemas de inhalación, así como determinar las posibles variables que puedan influir en la correcta realización de la técnica inhalatoria (TI).Diseño. Estudio descriptivo transversal. Emplazamiento. Centro de atención primaria urbano. Participantes. Un total de 141 asmáticos. Mediciones principales. Realización de un test práctico donde se evaluaba paso a paso la TI para cada uno de los diferentes sistemas de inhalación siguiendo las normativas SEPAR-SemFYC. Por cada maniobra correctamente realizada, se asignaba un punto. La técnica se consideraba correcta si se obtenía una puntuación total > 9. La variable principal fue el porcentaje de pacientes que realizaban bien la TI. Resultados. Un 77,3 por ciento eran mujeres, con una media de edad de 56,08 ñ 18,99 años. La TI fue incorrecta en el 53,9 por ciento de los pacientes (el 51,06 por ciento de los que utilizaban inhalador de cartucho presurizado [ICP], el 59,1 por ciento de los ICP + cámara, el 38,5 por ciento de Turbuhaler y el 37,5 por ciento Accuhaler). Las maniobras con mayor porcentaje de error fueron: espiración previa a la inhalación (63,78 por ciento), mantenimiento de la apnea postinspiración (65,94 por ciento), espiración lenta tras la inhalación (64,86 por ciento).A menor edad y mayor nivel de estudios, se constataba una mejor realización de la TI (p = 0,007). No se encontraron diferencias estadísticamente significativas en el resto de variables. Conclusiones. Se produjo un elevado porcentaje de pacientes con TI incorrecta. No podemos concluir que exista un sistema mejor que otro. Las variables relacionadas con la correcta realización de la TI son la edad y el nivel de estudios. Es necesario intensificar la educación sanitaria sobre el manejo de los diversos sistemas de inhalación (AU)

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