Jesús Molina

Spanish guideline for COPD (GesEPOC). Update 2014.

aServicio de Neumologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain bCIBER de Enfermedades Respiratorias (CIBERES), Spain cUnidad de Neumologia, Servicio de Medicina Interna, Hospital de Requena, Valencia, Spain dServicio de Neumologia, Hospital Clinico San Carlos, Madrid, Spain eCentro de Salud Francia, Direccion Asistencial Oeste, Madrid, Spain fServicio de Medicina Interna, Hospital Universitari Mutua de Terrassa, Terrasa, Barcelona, Spain gCentro de Salud Lucena I, Lucena, Cordoba, Spain hServicio de Neumologia, Hospital San Pedro de Alcantara, Caceres, Spain iCentro de Salud Menasalbas, Toledo, Spain jServicio de Urgencias, Hospital General Universitario Reina Sofia, Murcia, Spain kServicio de Urgencias, Hospital General Yague, Burgos, Spain lMedicina Fisica y Rehabilitacion, Parc de Salut Mar, Grupo de Investigacion en Rehabilitacion, Institut Hospital del Mar d’Investigacions Mediques, Universitat Autonoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain mUnidad de Fisioterapia Respiratoria, Hospital Universitario de Gran Canaria Dr. Negrin, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Spain nServicio de Medicina Fisica y Rehabilitacion, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain nServicio de Medicina Fisica y Rehabilitacion, Hospital Parc Tauli, Universitat Autonoma de Barcelona, Sabadell, Barcelona, Spain oCentro de Salud Gandhi, Madrid, Spain pServicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, Spain qFundacion Caubet-Cimera FISIB Illes Balears, Bunyola, Baleares, Spain rServicio de Neumologia, Hospital Universitario de la Princesa, Instituto de Investigacion Sanitaria Princesa (IP), Madrid, Spain

Recomendaciones para la atención al paciente con enfermedad pulmonar obstructiva crónica

disponibles, es imprescindible. Sólo así, sobre la base de una eficaz coordinación del trabajo llevado a cabo por ambos niveles asistenciales, se alcanzará la adecuada atención médica de estos pacientes. Ese es, en definitiva, el objetivo de esta guía y de las recomendaciones que en ella se presentan. Fueron hechas con un sentido eminentemente práctico y buscando que pudieran ser aplicadas en todo el territorio nacional. El tiempo dirá, si es que tienen éxito, hasta qué punto han acertado sus autores.

A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD guidelines (GesEPOC).

After the development of the COPD Strategy of the National Health Service in Spain, all scientific societies, patient organisations, and central and regional governments formed a partnership to enhance care and research in COPD. At the same time, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) took the initiative to convene the various scientific societies involved in the National COPD Strategy and invited them to participate in the development of the new Spanish guidelines for COPD (Guía Española de la EPOC; GesEPOC). Probably the more innovative approach of GesEPOC is to base treatment of stable COPD on clinical phenotypes, a term which has become increasingly used in recent years to refer to the different clinical forms of COPD with different prognostic implications. The proposed phenotypes are: (A) infrequent exacerbators with either chronic bronchitis or emphysema; (B) overlap COPD-asthma; (C) frequent exacerbators with emphysema predominant; and (D) frequent exacerbators with chronic bronchitis predominant. The assessment of severity has also been updated with the incorporation of multidimensional indices. The severity of the obstruction, as measured by forced expiratory volume in 1 second, is essential but not sufficient. Multidimensional indices such as the BODE index have shown excellent prognostic value. If the 6-minute walking test is not performed routinely, its substitution by the frequency of exacerbations (BODEx index) provides similar prognostic properties. This proposal aims to achieve a more personalised management of COPD according to the clinical characteristics and multidimensional assessment of severity.

Guía española de la EPOC (GesEPOC). Actualización 2014

Servicio de Neumología, Hospital Universitari Vall d’Hebron, Barcelona, Spain CIBER de Enfermedades Respiratorias (CIBERES), Spain Unidad de Neumología, Servicio de Medicina Interna, Hospital de Requena, Valencia, Spain Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, Spain Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrasa, Barcelona, Spain Centro de Salud Lucena I, Lucena, Córdoba, Spain Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain Centro de Salud Menasalbas, Toledo, Spain Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain Servicio de Urgencias, Hospital General Yagüe, Burgos, Spain Medicina Física y Rehabilitación, Parc de Salut Mar, Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain Unidad de Fisioterapia Respiratoria, Hospital Universitario de Gran Canaria Dr. Negrín, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Spain Servicio de Medicina Física y Rehabilitación, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain Servicio de Medicina Física y Rehabilitación, Hospital Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain Centro de Salud Gandhi, Madrid, Spain Servicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, Spain Fundación Caubet-Cimera FISIB Illes Balears, Bunyola, Baleares, Spain Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, SpainServicio de Neumología, Hospital Universitari Vall d’Hebron, Barcelona, España CIBER de Enfermedades Respiratorias (CIBERES), España Unidad de Neumología, Servicio de Medicina Interna, Hospital de Requena, Valencia, España Servicio de Neumología, Hospital Clínico San Carlos, Madrid, España Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, España Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrasa, Barcelona, España Centro de Salud Lucena I, Lucena, Córdoba, España Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España Centro de Salud Menasalbas, Toledo, España Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España Servicio de Urgencias, Hospital General Yagüe, Burgos, España Medicina Física y Rehabilitación, Parc de Salut Mar, Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, España Unidad de Fisioterapia Respiratoria, Hospital Universitario de Gran Canaria Dr. Negrín, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, España Servicio de Medicina Física y Rehabilitación, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España Servicio de Medicina Física y Rehabilitación, Hospital Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España Centro de Salud Gandhi, Madrid, España Servicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, España Fundación Caubet-Cimera FISIB Illes Balears, Bunyola, Baleares, España Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, España

Exacerbations worsen the quality of life of chronic obstructive pulmonary disease patients in primary healthcare

Aims:  To investigate the evolution of the quality of life of patients with chronic obstructive pulmonary disease (COPD) and quantify the impact of exacerbations on the deterioration of quality of life over 2 years.

Factors determining the quality of life of patients with COPD in primary care

Objectives: To describe the health-related quality of life (HRQL) in a cohort of COPD patients recruited in primary care and identify the variables of the patients and the treatment associated with impaired HRQL. Method: Multicenter, observational study of patients with COPD recruited in Primary Care centers. Data regarding HRQL measured by the St. Georges respiratory questionnaire (SGRQ) are presented. The total population was divided into two subgroups, high and Low SGRQ, using the median of the total SGRQ score. Univariate analysis and logistic regression analysis with calculation of adjusted odds ratios were used to investigate the factors significantly associated with a higher SGRQ score (poor HRQL). Results: A total of 27 investigators included 222 valid patients with a mean age of 68.2 years (SD = 9.9) and a mean FEV1(%) of 49.2% (SD = 15.4%). The median total SGRQ score was 39.5 and patients with a high score had a longer evolution of COPD (p < 0.0001), more severe dyspnea (p < 0.0001) and a worse FEV1(%) (46.3% vs. 51.9%; p = 0.008). Factors independently associated with the total SGRQ score were cough and dyspnea, duration of COPD and treatment with inhaled steroids. Conclusion: Patients with COPD controlled in primary care demonstrate an important impairment in HRQL, with chronic cough and dyspnea being associated with more impaired HRQL. Strategies aimed at modifying these factors should significantly improve the well-being of COPD patients.

Economic evaluation of the antibiotic treatment of exacerbations of chronic bronchitis and COPD in primary care

This was an observational and economic survey performed in primary care practices throughout Spain to assess the effectiveness and direct medical costs derived from antibiotic treatment of exacerbations of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) in primary care.

Effect of Various Antimicrobial Regimens on the Clinical Course of Exacerbations of Chronic Bronchitis and Chronic Obstructive Pulmonary Disease in Primary Care

AbstractAim: To assess whether the empirical administration of different antibiotics for exacerbations of chronic bronchitis and chronic obstructive pulmonary disease (COPD) in the primary-care setting is associated with a different clinical course, principally related to the speed of onset of action. Design and setting: Observational, non-randomised, open-label study carried out between February 2001 and May 2002 in 252 primary-care practices in Spain. Participants: The study included patients diagnosed with an exacerbation of chronic bronchitis or COPD. Information was requested on the first ten patients attending each clinic with a diagnosis of exacerbation of their chronic bronchitis or COPD within the study dates. All patients were followed up for 30 days, with an intermediate visit at 10 days at which they were asked about the duration of the symptoms; the presence of symptoms was assessed at 3, 5 and 10 days. Three antibiotic regimens were evaluated: amoxicillin 500mg plus clavulanic acid 125mg (co-amoxiclav) three times daily for 10 days, clarithromycin 500mg twice daily for 10 days, and moxifloxacin 400mg once daily for 5 days. Results: 252 general practitioners participated in the study, registering 1456 patients who met inclusion criteria. The clinical cure rate, defined as the remission of the three cardinal symptoms of exacerbation (increased expectoration, change in sputum purulence, and increased dyspnoea) were similar on the tenth day: 67% in the group receiving moxifloxacin, 65% in those taking co-amoxiclav, and 64% in those taking clarithromycin (p = 0.38). However, differences in the clinical cure rates were observed on day 3 (moxifloxacin 20%, co-amoxiclav 9.6%, and clarithromycin 6.5%) and day 5 (moxifloxacin 49%, co-amoxiclav 26.5% and clarithromycin 30%). The cure rates were significantly higher in the moxifloxacin group than in either of the other two treatment groups (p < 0.001 for both days). Conclusions: The aim of antimicrobial therapy should be to reduce both the rate of therapeutic failure and the duration of symptoms. Even though the clinical cure rates in this study were similar at 10 days, the time to resolution of symptoms was shorter in the patients in the moxifloxacin group than in the other two groups.

Factors associated with depression and severe depression in patients with COPD

BACKGROUND Depression is very prevalent in COPD and may be associated with poor clinical outcomes. METHOD This was a multicenter, cross-sectional study aimed at evaluating the prevalence of depression and moderate to severe depression in COPD. Depressive symptoms were evaluated with the Becks Depression Inventory. The COPD assessment test (CAT) and the EuroQoL-5 dimensions (EQ-5D) questionnaires were used to evaluate health-related quality of life (HRQoL). Severity of COPD was assessed with the BODEx index and physical activity was estimated by the mean self-declared time walked per day. RESULTS A total of 836 patients were included and up to 74.6% had some degree of depression with 51.5% having moderate to severe depression. On multivariate analysis, moderate to severe depression was associated with suicidal ideation (OR, 6.12; 95% confidence interval (CI), 1.36-28.24), worse quality of life: EQ-5D (OR, 0.89; 95%CI, 0.86-0.93) and worse CAT scores (OR, 1.32; 95%CI, 1.19-1.46). When questionnaires were not included in the analysis, significant depression was associated with the Charlson comorbidity index, minutes walked per day and BODEx score. CONCLUSIONS Depression is frequent in COPD and is associated with suicidal ideation, impaired HRQoL, increase in comorbidities, a reduction in physical activity and increased severity of COPD measured by the BODEx index.

The IDDEA project: a strategy for the detection of alpha-1 antitrypsin deficiency in COPD patients in the primary care setting:

Objective: Primary care provides the main route for access to health care for patients with common chronic illnesses such as chronic obstructive pulmonary disease (COPD). Alpha-1 antitrypsin (AAT) deficiency is an underdiagnosed pathology associated with COPD risk which has a very low prevalence. The Information and Detection of the Deficiency of AAT (IDDEA) project was developed to identify AAT-deficient patients at primary care centres by providing adequate diagnostic tools to family doctors. Methods: Patients with COPD were identified and registered on a specially designed website. Dried blood samples were collected on filter papers and sent to the laboratory for AAT levels and AAT deficiency-related genotype determinations. Results were uploaded to the website and analysed. Results: Between January 2008 and April 2009, 596 patients were identified by 90 participating physicians. The number of patients who did not have AAT deficiency (serum concentrations ≥60 mg AAT/dl) was 549 (98.9%). Nineteen patients (3.2%) were carriers of the allelic variant Pi*Z among which two were homozygous PiZZ (one of them was an index case) and one was heterozygous PiSZ. These three newly detected cases were registered in the Spanish Registry of Patients with AAT Deficiency. An estimate of the gene frequency of the S allele was 7.65% and the severe deficiency Z allele was 1.76%. Conclusions: Results confirm that ATT deficiency is still underdiagnosed. The IDDEA system appears to be a useful tool for the detection of AAT deficiency in the primary care setting.