COPD guides and inhaled corticosteroids. Is there an adequate use in primary care?

Abstract

Introduction: COPD guidelines GOLD 2011 and GesEPOC 2012 emerged almost simultaneously, recommending a new approach on COPD, causing some confusion amongst health professionals.

Aims and objectives:

1. To determinate the number of patients that are being correctly treated with inhaled corticosteroids (ICS) according to the disease's stage and the different guides.

2. To determinate the percentage of patients treated correctly according to the stage, severity and guide used (GOLD or GesEPOC).

Methodology: Multicentre transversal study in Barcelona city. A total of 401 patients diagnosed of COPD (FEV1/FVC after bronchodilatiation < 0,70 in spirometry testing), from 6 Primary Attention centres, were included. The treatment prescribed to the patients was analyzed and compared to the recommendations given in both guides. Statistical bivariate analysis was followed.

Results: If we analyse the ICS treatment according to GOLD's classification, the highest percentage of prescribed ICS is in stage B (81,5%). Although according to GesEPOC's, we find it in phenotype D (80%). The adequacy of prescribed treatment according to GOLD's guide is correct in 89,5% of the patients in stage B. On the other hand, according to GesEPOC's guide, 70,6% of phenotype C patients have ICS adequately prescribed.

Conclusions: There is a high percentage of patients in mild and moderate stages who should not have ICS prescribed conceding with GOLD's guide. Conversely, the same happens with phenotype A patients regarding GesEPOC's guide. ICS prescription is accurate in the other stages and phenotypes. Globally, we can observe a better treatment adequacy in mild and very severe stages (GOLD), and in phenotypes A and C (GesEPOC).