J. Galera

Differences between physician and patient in the perception of symptoms and their severity in COPD.

Chronic Obstructive Pulmonary Disease (COPD) impairs quality of life and presents symptoms that affect the lives of patients. Our study analysed the degree of concordance between the patients and their pulmonologists in the perception of the severity of symptoms. A cross-sectional, descriptive, multicentre study was conducted in patients with COPD. From a list of 10 symptoms (cough, dry mouth, chest pain, expectoration, wheezing/whistling in the lungs, depression/sadness/discouragement, fatigue/tiredness/general lack of energy, anxiety/nervousness, breathlessness/shortness of breath upon exertion and difficulty sleeping/sleep disorders) each investigator and patient assessed those which, in their opinion, most concerned or affected the patient. A total of 450 patients were included in the study (91.3% males, 66.7 years old (SD = 10.2), FEV1(%) 51.7% (SD = 12.7%)). At an aggregate level, breathlessness/shortness of breath, fatigue/tiredness and coughing were identified by patients and physicians as being the most relevant symptoms. However, according to the concordance analysis conducted with individual pairs (each pulmonologist with his/her patient), only 52.8% coincided when identifying the symptom that most concerned or affected the life of the patient. The concordance analysed by the Kappa index between patients and physicians was poor (<0.42). The degree of physician-patient concordance was greater in patients with more severe COPD. The patients and their pulmonologists identified the same three main symptoms of COPD but showed low concordance when assessing the impact of the symptoms of the illness.

Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting.

Background: The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD). Methods: A retrospective analysis was carried out on a claim database. Patients aged at least 40 years with a diagnosis of COPD were eligible for this analysis. Demographics, medical data and use of resources were collected and direct and indirect costs were analysed (from January 2008 to June 2009). A probabilistic multivariate sensitivity analysis of avoided costs was carried out. All results are presented in annualized form and costs are expressed in Euros (2009). Results: A total of 1365 patients were included, 79.5% were men. The mean age (±standard deviation) was 71.4 (±10.3) years, the mean forced expiratory volume in 1 s (FEV1) was 65.3% and they had a COPD history of 5.5 (±2.9) years. Patients were divided into an adherent group and a nonadherent group depending on whether therapeutic recommendations according to severity defined in the GOLD guidelines (2007) were followed. Patients in both groups were also classified as having stage II (FEV1 < 80% and < 50%) or stage III disease (FEV1 < 50% and ≥ 30%). The total annual drug cost per patient in the nonadherent group was €771.5 while it was only €426.4 for the adherent group. The average direct cost per patient per year in the nonadherent stage II group was €1465 (±971) and it rose to €2942 (±1918) for patients in the nonadherent group with stage III disease. The potential saving from the implementation of the GOLD guidelines in stage II COPD amounted to €758 per patient per year (68% saving on drug cost). In contrast, the cost for patients with stage III disease was higher in the adherent group versus the nonadherent group (€2468). Conclusions: The cost of COPD may vary according to compliance with the GOLD guidelines. The cost observed for patients with stage II disease is higher than expected in patients who adhere to treatment, but patients with stage III disease treated according to the GOLD guidelines had significantly higher treatment costs.

Factores asociados con el asma grave no controlada y con la percepción del control por parte de médicos y pacientes

INTRODUCTION Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control. METHODS Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control. RESULTS According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only). CONCLUSIONS Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.

PRS42 VALIDATION OF THE SPANISH VERSION OF THE “COPD AND ASTHMA FATIGUE SCALE (CAFS)” QUESTIONNAIRE

was conducted. RESULTS: Overall, 20,488 cases were included in the analysis. After the adjustment for age, sex, body-mass-index and duration of education there is a statistically significant association between consumption of tobacco and HRQoL in all subscores as well as both composite scores of the SF-12. The regression coefficients for current smoking (all non-smokers as reference group) are relatively small with 0.68 (role physical) to 1.35 (general health) points for physical domains and between 0.58 (vitality) and 1.47 (mental health) points for mental domains. These differences increase considerable for elderly persons (age of 50 or older, N 9830) with 1.274 (role physical) to 1.87 (general health) points for physical and 0.953 (vitality) to 1.682 (social functioning) for mental scales. Equally, there is a strong statistical association between the current amount of smoking (per 10 cigarettes per day) and HRQoL ( 0.342 to 0.858 for physical and 0.47 to 1.07 for mental domains, N 5560). CONCLUSIONS: In particular, the findings are limited by the inconclusive causality direction for smoking and mental health. However, these results confirm the existing evidence concerning the negative association between smoking status or smoking intensity and HRQoL in a general population.

PRS41 VALIDATION OF THE SPANISH VERSION OF THE “LIVING WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (LCOPD)” QUESTIONNAIRE

was conducted. RESULTS: Overall, 20,488 cases were included in the analysis. After the adjustment for age, sex, body-mass-index and duration of education there is a statistically significant association between consumption of tobacco and HRQoL in all subscores as well as both composite scores of the SF-12. The regression coefficients for current smoking (all non-smokers as reference group) are relatively small with 0.68 (role physical) to 1.35 (general health) points for physical domains and between 0.58 (vitality) and 1.47 (mental health) points for mental domains. These differences increase considerable for elderly persons (age of 50 or older, N 9830) with 1.274 (role physical) to 1.87 (general health) points for physical and 0.953 (vitality) to 1.682 (social functioning) for mental scales. Equally, there is a strong statistical association between the current amount of smoking (per 10 cigarettes per day) and HRQoL ( 0.342 to 0.858 for physical and 0.47 to 1.07 for mental domains, N 5560). CONCLUSIONS: In particular, the findings are limited by the inconclusive causality direction for smoking and mental health. However, these results confirm the existing evidence concerning the negative association between smoking status or smoking intensity and HRQoL in a general population.