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Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
To the Editor:
Chronic obstructive pulmonary disease (COPD) is a very prevalent disease in developed countries. It is estimated that between 7–10% of the adult population may be affected 1. In recent years, many scientific societies have published guidelines for the treatment of these patients, one of the most ambitious of which is the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2. However, management patterns of the disease in both primary care and specialised settings differ from those proposed by experts. In a recent issue of the European Respiratory Journal, Roche et al. 3 presented data on the treatment of COPD by respiratory physicians in France. Their results showed that 41.6% of patients remained untreated. This figure contrasts with the 12% 4 and 5% 5 of patients untreated in two different large surveys of primary care in Spain. Similarly, in a population-based study, only 22% of patients identified as having COPD in the general population had been diagnosed previously, but among those diagnosed, only 12% were not receiving any treatment for their respiratory disease 1. These results highlight important differences in COPD management between the two countries.
Another interesting aspect of their study was the demonstration that treated patients received a mean of 2.6 drugs 3. In a recent study on moderate-to-severe COPD patients treated by respiratory physicians, we observed that 44% of patients were receiving at least three different drugs for their respiratory disease 6. Interestingly, an increased number of drugs prescribed was associated with more severe impairment of health status, as measured by the St George's respiratory questionnaire.
Impairment of the forced expiratory volume in one second (FEV1) or baseline dyspnoea was associated with increased prescription of respiratory drugs, with the exception of anticholinergics 3. In our survey on primary care, impairment in FEV1 was again significantly associated with increased drug prescription, including anticholinergics. However, other factors, such as age, male sex and chronic mucus hypersecretion, explained part of the variability in the prescription of different therapeutic groups 4. Impairment of FEV1 or baseline dyspnoea was associated with increased prescription of drugs in moderate-to-severe COPD patients managed by respiratory physicians. However, in our study, comorbidity was also significantly associated with increasing treatment in this population 6.
Management of patients with COPD may differ in different countries and over time. A comparison of different studies providing data on COPD management is presented in table 1
. It is interesting to observe the large differences in the prescription of different drugs; for example, theophylline use ranges from 10–45% and inhaled corticosteroids from 26–76%.
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References
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  G. G. Riario-Sforza, C. Incorvaia, C. Pravettoni, and N. Dugnani Guidelines versus clinical practice in the treatment of COPD: a reappraisal. Eur. Respir. J., March 1, 2006; 27(3): 656 - 656. [Full Text] [PDF]
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