Assessment of physical functioning in patients with chronic obstructive pulmonary disease (COPD) requiring long-acting dual bronchodilation in routine clinical practice

OBJECTIVE

We aim to determine the effect of a fixed-dose combination (FDC) of tiotropium/olodaterol on Physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) in a real world setting.

METHODS

COPD patients were prospectively enrolled to evaluate the effect of a FDC of tiotropium/olodaterol inhaler therapy via the Respimat® Soft Mist™ inhaler (SMI) on the physical functioning scale (PF-10), and the general condition of the patient as assessed by the physician (Physician's Global Evaluation, PGE), and the patient's satisfaction after 6 weeks of treatment. The primary end-point was the percentage of patients with therapeutic success at 6th week follow-up, defined as a ≥10-points increase in the standardised PF-10 score from baseline.

RESULTS

A total of 257 patients from 57 sites were enrolled, and 234 completed the follow up. After 6 weeks of treatment, 155 out of 234 patients (66.2%) showed therapeutic success in the physical functioning score, coupled with significant improvement in PGE score: 78 (33.3%) patients with good/excellent PGE score at baseline, increasing to 172 (73.5%) at 6th week (p<0.0001). The patient's satisfaction was excellent: 77.2% reporting to be satisfied/very satisfied with the treatment, 79.9% with inhaling and 79.0% with the handling of SMI device. 1.6% of patients reported an investigator-defined drug-related adverse event.

CONCLUSION

Treatment of COPD patients with a FDC of tiotropium/olodaterol SMI for 6 weeks resulted in significant improvements in the patients' condition as assessed by patients and physicians, with no new safety findings.

Referral Criteria for Asthma: Consensus Document

Asthma is one of the most prevalent chronic diseases in Spain. Current treatments ensure that the disease is controlled in most cases. However, disease is often uncontrolled in daily clinical practice, mainly owing to underdiagnosis, loss to follow-up, and poor adherence to therapy. In order to improve this situation, we must coordinate all those health professionals who intervene in patient care. Therefore, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG), and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) have drawn up a consensus document in which they establish criteria for referral and guidelines for the diagnosis, control, and follow-up of patients with asthma. The document aims to facilitate continuing and improved care in this area.

[Cost and management of asthma attacks treated in primary care (COAX Study)]

OBJECTIVES

To estimate the cost and characterize the management of asthma attacks in primary care.

DESIGN

Prospective, observational study of 1 year's duration. Setting. 10 physician's offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain.

PARTICIPANTS

10 family physicians who saw 133 consecutive patients with an asthma attack.

METHOD

Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians' habitually used procedures; the study protocol did not specify any predetermined intervention.

RESULTS

The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was 166.7 (95% CI, 146.5-192.3); 80% (132.4) (95% CI, 122.7-143.8) were direct costs and 20% (34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician.

CONCLUSIONS

Mean cost of each asthma attack treated in primary care was 166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs.

[Effectiveness of a recuperative primary care intervention in patients with chronic obstructive pulmonary disease]

OBJECTIVES

The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease.

DESIGN

Pragmatic cluster-randomised clinical trial.

SETTING

Clinics of 16 PC teams in various health areas of the Community of Madrid.

PARTICIPANTS

476 patients with light-moderate COPD, who sign their informed consent.

VARIABLES

Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise.

METHOD

The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated.

DISCUSSION

This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD.

Factors Affecting Drug Prescription in Patients With Stable COPD: Results From a Multicenter Spanish Study

OBJECTIVE

To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD).

MATERIAL AND METHODS

We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing.

RESULTS

The forced expiratory volume in 1 second was significantly associated with prescription of long-acting beta2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40-97.02). Body mass index was not related to drug administration.

CONCLUSIONS

Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea.

[Quality of life with chronic obstructive pulmonary disease: the influence of level of patient care]

OBJECTIVE

The aim of the study was to determine the factors related to the health-related quality of life (HRQL) of patients with stable chronic obstructive pulmonary disease (COPD) and to assess the degree of influence of level of patient care (primary or specialized).

MATERIAL AND METHOD

An observational descriptive, cross-sectional, multicenter study was carried out. The study sample was a randomized selection taken from a stratified sample of patients treated by primary care physicians and pneumologists from each Spanish region. Only those patients whose level of health care was indicated and whose diagnosis of COPD was confirmed by spirometry were enrolled in the study.

RESULTS

Five hundred sixty patients were assessed, 100 from primary health care and 460 from pneumology practices. No significant differences between the 2 levels of care were found in the scores on the HRQL questionnaire (Spanish version of the St George's Respiratory Questionnaire). There was a weak correlation between patients' perception of health and lung function parameters. Factors related to HRQL in the multivariate analysis were dyspnea, the presence of COPD exacerbations in the previous year, consequent visits to the emergency department, age, and degree of airflow restriction, but not level of patient care.

CONCLUSIONS

Stable COPD patients' HRQL is not related to their level of care, be it primary or specialized, but is related to other factors such as dyspnea, presence of exacerbations or consequent visits to the emergency department, age, and degree of airflow restriction.

[Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors]

OBJECTIVE

The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease.

MATERIAL AND METHODS

This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists.

RESULTS

Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD.

CONCLUSIONS

Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD.

[Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols]

OBJECTIVE

The aims of this study were to identify the drug treatment protocols applied by primary care physicians or pneumologists for patients with stable chronic obstructive pulmonary disease (COPD) in Spain, to determine the agreement between prescription practices and current recommendations and to assess differences between the two levels of patient care.

PATIENTS AND METHODS

The study was observational, descriptive and multicenter. A stratified random sample of patients treated by family physicians or pneumologists was taken for every region in Spain.

RESULTS

Five hundred sixty-eight (63.2%) of the 898 subjects fulfilled COPD diagnostic criteria; 100 were treated by primary care physicians and 460 by pneumologists. In 8 cases the caregiver was unknown. Obstruction was mild-to-moderate in 144 cases and severe in 416. The drugs most commonly prescribed were ipratropium bromide (77.8%), inhaled short-acting beta(2) agonists (65.8%), inhaled corticosteroids (61.0%), long-acting beta(2) agonists (46.4%) and theophyllines (41.3%). Primary care physicians prescribed inhaled short-acting beta 2-agonists most often, whereas pneumologists prescribed anticholinergics most often. In the primary care setting, no differences in treatment protocols were observed based on severity of COPD, degree of dyspnea or quality of life. More consistent differences were seen in treatment by pneumologists. In both settings, prescription was more frequently given when COPD was severe. The most commonly prescribed inhalation device was the Turbuhaler in primary care and the pressurized canister in pneumology.

CONCLUSIONS

Treatments prescribed for COPD patients do not follow current guidelines strictly, particularly in the primary care setting. Different prescription protocols are used at the different levels of patient care.

[Prevalence of anti-smoking counseling in a primary care clinic: comparison of patient charts with patient reports]

OBJECTIVE

To estimate the prevalence of anti-tobacco counseling of smokers.

DESIGN

Cross-sectional, descriptive study.

SETTING

Primary care center.

SUBJECTS

Random sample of 1,228 patients over 14 years of age who visited a doctor or nurse over the year prior to the study.

MEASURES

1) Telephone interview: age, sex, medical history, education, smoking status, number of cigarettes daily, frequency of visits to the doctor, receipt of anti-smoking advice, reason for seeking medical care, the type of professional who saw the patient and the patient's attitude toward the advice. 2) Patient chart: record of advice given.

RESULTS

Five hundred sixty-three questionnaires were valid. Smokers made up 37% (95% CI 33%-41%) of the population, with a mean age of 33.37 (18.14 years; 39.1% of men and 36.1% of the women smoked. The prevalence of anti-smoking counseling according to the patient was 62.3% (95% CI: 56-69%). There was little agreement between counseling as reported by the patients and as recorded in the patient's chart (kappa index 0.149, p = 0.01). The mean age of patients advised to quit (34.8 + 10.89 years) was higher than that of those who did not receive advice to quit. Seventy percent of patients who came to the clinic more than 3 times per year reported having been advised to quit, whereas 50% of those who came fewer than 3 times per year were so advised. Among patients who were advised to quit, 78.3% said the advice came when they had come to the clinic about matters related to smoking. According to patients, advice was usually given by a doctor (76.7%). After being advised to quit, 32.55% of the smokers did so, 6.2% of them for longer than 6 months.

CONCLUSIONS

The percentage of smokers at our clinic is similar to that in the general population. The prevalence of anti-smoking counseling reported by the user is greater than that reported in other studies, but can clearly be improved. Anti-smoking advice is underreported in our patient charts in comparison with patient reports. The patients who receive advice most often are those who come to the clinic frequently and those who come for smoking-related problems. Physicians are the professionals who most often advise patients on smoking.

[Benzodiazepine prescription at a health center: prevalence, its use and user characteristics]

OBJECTIVES

To find the prevalence of prescription of benzodiazepines (BDZ) in 1997 at a health centre (HC), and the characteristics of both their consumption and the takers.

DESIGN

Crossover, observational study.

SETTING

Primary care urban centre.

PATIENTS

From a total of 7356 patients over 14 with clinical records and belonging to four lists, a random sample stratified by lists was selected.

INTERVENTION

A form was used to gather social and demographic data, educational level, family context, linked pathologies, number of visits to HC per year, BDZ prescription and variables defining the kind of consumption.

MAIN RESULTS

The prevalence of BDZ prescription was 7.7% (CI, 6-10%). Consumption profile: 33% long BDZ, 31% intermediate and 33% short. 44% consumed BDZ occasionally or for less than 2 weeks, and 42% had been taking it for over a year. For 56% (95% CI, 40-70) their G.P. was the origin of the prescription. The reason for the prescription was not specified in 42% of cases. The variables which defined the profile of the consumers, included in the logistic regression, were: sex, number of visits and linked pathologies, whose OR were: 1.57 (CI, 1.08-2.03), 1.11 (CI, 1.06-1.17) and 1.61 (CI, 1.04-2.05).

CONCLUSIONS

The prevalence of BDZ prescription during 1997 in the population seen at our clinics was very similar to the figures found in other studies, with higher annual consumption averages and without the reason for taking it being specified in half the cases. The profile of BDZ takers was: mainly women, people with linked pathologies, and as a function of the number of attendances.

Methanosarcina mazei JC2, a new methanogenic strain isolated from lake sediments, that does not use H2/CO2

A new mesophilic methanogenic strain, which produced methane from acetate, methanol, and methylamines, was isolated from lake sediments obtained from the lake Banyoles, near Girona (Spain). The cells were irregular in shape, from 1 to 3 micron in diameter, aggregated in masses of a few to several hundred units. Colonies were about 1-2 mm and irregularly shaped. Their color was yellow or white. Growth occurred throughout the pH range of 5 to 9 with optimal growth around pH 7. The optimal growth temperature was 37 degrees C. The molar deoxiribonucleic acid base composition was 37.2% (G + C). Studies of DNA homologies showed that this isolated was a strain of Methanosarcina mazei, but it differs from other reported strains, in that was not able to use H2/CO2 for growth or methane production.