Encuesta a neumonologos sobre el diagnostico y tratamiento de EPOC / Survey of chest physicians regarding COPD diagnosis and treatment

A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed). They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria). Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S), and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8%) followed by nebulization (16.5%), dry powder inhalation (13.7%) and oral administration (4.8%). First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC) + short acting beta2-agonists (SABA) (65.5%), AC alone (18.8%), long acting beta2-agonists (LABA) (9.7%), inhaled corticosteroids (IC) (3.5%) and SABA alone (2.8%). Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice antibiotic formulation was beta-lactamics + beta-lactamase inhibitors in 39% of the responders followed by fluorquinolones in 23.7%, macrolides in 17.5% and beta-lactamics in 12.5%. Lastly, 12.7% of COPD patients received long-term domiciliary oxygen therapy. 59.3% of them were prescribed pulmonary rehabilitation, 94.1% vaccination against in...

Se realizo una encuesta acerca de diagnostico y tratamiento de EPOC a un grupo de 517 especialistasen neumonologia, seleccionados al azar entre los 1121 integrantes de la Asociacion Argentina de Medicina Respiratoria. Se obtuvieron 187 respuestas (36.2%). Atienden en promedio 53.3 pacientes con EPOC/mes, a los cuales definen como leves el 24.2%, moderados el 41.8% y severos el 33.8% (criterios normativos GOLD).El criterio utilizado para el diagnostico de EPOC fue solo clinico en el 2.9%, clinico y espirometria (ESP) en el 23.4%y clinico, ESP y por imagenes en el 73.7%. El 70.1% de los encuestados incluye dentro de la definicion de EPOC al asma cronico de escasa respuesta a broncodilatadores. Solo el 14.1% manifiesta realizar espirometria en cada consulta. La evaluacion de la funcion cardiaca la realizan en EPOC severa por examen clinico (90.6%), electrocardiograma (80.6%) y ecocardiograma (73.8%). El 98.3% de los encuestados afirma que la mayoria de los pacientes son instruidosen la realizacion de maniobras de inhalacion de medicamentos. Eligieron como primera opcion para administrarbroncodilatadores en aerosol (64.8%), nebulizacion (16.5%), polvo (13.7%) y via oral (4.8%). El 65.5% eligio comoprimera opcion de tratamiento cronico a los anticolinergicos (AC) + beta2-agonistas de acción corta (BAAC), 18.8% ACsolos, 9.7% beta2-agonistas de accion larga (BAAL), 3.5% corticoides inhalados (CI) y 2.8% BAAC solos. Los corticoides sistemicos y los antibioticos fueron utilizados en las reagudizaciones severas por el 92.5% y el 70% de los encuestados, respectivamente. En esa situacion, como antibioticos de primera eleccion, fueron elegidos los beta lactamicos + inhibidores de beta-lactamasa por el 39.1% de los encuestados, fluorquinolonas (23.7%), macrolidos (17.4%) y betalactamicos...

Encuesta a neumonologos sobre el diagnostico y tratamiento de EPOC / Survey of chest physicians regarding COPD diagnosis and treatment

A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed). They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria). Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S), and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8%) followed by nebulization (16.5%), dry powder inhalation (13.7%) and oral administration (4.8%). First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC) + short acting beta2-agonists (SABA) (65.5%), AC alone (18.8%), long acting beta2-agonists (LABA) (9.7%), inhaled corticosteroids (IC) (3.5%) and SABA alone (2.8%). Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice antibiotic formulation was beta-lactamics + beta-lactamase inhibitors in 39% of the responders followed by fluorquinolones in 23.7%, macrolides in 17.5% and beta-lactamics in 12.5%. Lastly, 12.7% of COPD patients received long-term domiciliary oxygen therapy. 59.3% of them were prescribed pulmonary rehabilitation, 94.1% vaccination against in...(AU)

Se realizo una encuesta acerca de diagnostico y tratamiento de EPOC a un grupo de 517 especialistasen neumonologia, seleccionados al azar entre los 1121 integrantes de la Asociacion Argentina de Medicina Respiratoria. Se obtuvieron 187 respuestas (36.2%). Atienden en promedio 53.3 pacientes con EPOC/mes, a los cuales definen como leves el 24.2%, moderados el 41.8% y severos el 33.8% (criterios normativos GOLD).El criterio utilizado para el diagnostico de EPOC fue solo clinico en el 2.9%, clinico y espirometria (ESP) en el 23.4%y clinico, ESP y por imagenes en el 73.7%. El 70.1% de los encuestados incluye dentro de la definicion de EPOC al asma cronico de escasa respuesta a broncodilatadores. Solo el 14.1% manifiesta realizar espirometria en cada consulta. La evaluacion de la funcion cardiaca la realizan en EPOC severa por examen clinico (90.6%), electrocardiograma (80.6%) y ecocardiograma (73.8%). El 98.3% de los encuestados afirma que la mayoria de los pacientes son instruidosen la realizacion de maniobras de inhalacion de medicamentos. Eligieron como primera opcion para administrarbroncodilatadores en aerosol (64.8%), nebulizacion (16.5%), polvo (13.7%) y via oral (4.8%). El 65.5% eligio comoprimera opcion de tratamiento cronico a los anticolinergicos (AC) + beta2-agonistas de acción corta (BAAC), 18.8% ACsolos, 9.7% beta2-agonistas de accion larga (BAAL), 3.5% corticoides inhalados (CI) y 2.8% BAAC solos. Los corticoides sistemicos y los antibioticos fueron utilizados en las reagudizaciones severas por el 92.5% y el 70% de los encuestados, respectivamente. En esa situacion, como antibioticos de primera eleccion, fueron elegidos los beta lactamicos + inhibidores de beta-lactamasa por el 39.1% de los encuestados, fluorquinolonas (23.7%), macrolidos (17.4%) y betalactamicos...(AU)

[Mortality rate for asthma and chronic obstructive pulmonary disease in Argentina from 1980-1998]. / Mortalidad por asma y enfermedad pulmonar obstructiva crónica en Argentina en el período 1980-1998.

UNLABELLED: The objective was to determine annual mortality rate for asthma and chronic obstructive pulmonary disease (COPD) from 1980 to 1998, in Argentina. Data base on death certificates from the National Ministry of Health were evaluated. They were individualized for COPD: ICD-9: 490 to 496 and ICD-10: J-40 to J47; for asthma: ICD-9: 493 and ICD-10: J44, J45-J46. Global mortality rate was calculated from each code and for 24 provinces. For asthma, the adjusted mortality rate for 5-34 year-old patients was calculated. Population data were provided by National Institute of Statistics and Census. Global mortality rate for asthma increased from 3.37 in 1980 to 3.96/100,000 in 1985 and decreased from 3.16 in 1991 to 1.74 in 1997 (-30.8%, p < 0.0001) and increased to 2.18 in 1998. Asthma's 5-34 year old mortality rate increased from 0.72 in 1980 to 1.12/100,000 in 1986, and decreased to 0.35 in 1998 (-70%, p < 0.0001). Global mortality rate for COPD increased from 12.76/100,000 in 1980 to 27.16/100,000 in 1998 (+113%, p < 0.0001). There were marked inter-provinces differences for asthma and COPD. IN CONCLUSION: as in developed countries, Argentine mortality rate for asthma has decreased, probably related to dissemination of international and national guides. On the other hand, COPD has increased significantly.

Mortalidad por asma y enfermedad pulmonar obstructiva crónica en Argentina en el período 1980-1998. / [Mortality rate for asthma and chronic obstructive pulmonary disease in Argentina from 1980-1998]

The objective was to determine annual mortality rate for asthma and chronic obstructive pulmonary disease (COPD) from 1980 to 1998, in Argentina. Data base on death certificates from the National Ministry of Health were evaluated. They were individualized for COPD: ICD-9: 490 to 496 and ICD-10: J-40 to J47; for asthma: ICD-9: 493 and ICD-10: J44, J45-J46. Global mortality rate was calculated from each code and for 24 provinces. For asthma, the adjusted mortality rate for 5-34 year-old patients was calculated. Population data were provided by National Institute of Statistics and Census. Global mortality rate for asthma increased from 3.37 in 1980 to 3.96/100,000 in 1985 and decreased from 3.16 in 1991 to 1.74 in 1997 (-30.8

, p < 0.0001) and increased to 2.18 in 1998. Asthmas 5-34 year old mortality rate increased from 0.72 in 1980 to 1.12/100,000 in 1986, and decreased to 0.35 in 1998 (-70

, p < 0.0001). Global mortality rate for COPD increased from 12.76/100,000 in 1980 to 27.16/100,000 in 1998 (+113

, p < 0.0001). There were marked inter-provinces differences for asthma and COPD. In conclusion: as in developed countries, Argentine mortality rate for asthma has decreased, probably related to dissemination of international and national guides. On the other hand, COPD has increased significantly.