This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program.

Abstract: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.

Study Objectives: Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists. Methods: This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test. Results: A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients. Conclusions: Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care.

The purpose of this study is to develop and validate a work model in the primary health-care setting for identifying patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) based on clinical variables and an ambulatory sleep monitoring study. After screening, patients with mild–moderate OSAHS could be managed by primary care physicians, whereas those identified with severe OSAHS would be referred to specialists from sleep units for starting specific treatment. The proposed model does not move the entire health-care process to a generally overburdened primary care level and favors the coordinated work and the necessary flexibility to adapt the model to challenges and perspectives of OSAHS.

The aim of this observational, retrospective study was to describe characteristics, treatment patterns, and adherence among patients with asthma who initiated multiple-inhaler triple therapy (MITT) in Catalonia, Spain. This study used data of patients initiating MITT in 2016 from the SIDIAP (Information System for Research in Primary Care) database, which covers ~80% of the Catalonian population (5.8 million). Of 1,204 patients initiating MITT, 361 (30.0%) stepped down (discontinued ≥ 1 and continued ≥1 MITT component) and 89 (7.4%) stopped all three components of MITT for a period of 60 days during the following 12 months. In the follow-up period, 196 (16.3%) patients were considered adherent to MITT (>0.8 proportion of days covered [PDC]), with a mean (standard deviation) PDC of 0.52 (0.51) days. Given the low adherence and substantial rates of step down/discontinuation among patients initiating MITT, there is an urgent need to implement strategies to improve treatment adherence/persistence.

Aims and objectives:To determine whether office spirometry (pre-and post-BD FEV1 measurement by the GP with handheld spirometer) contributes to diagnosing obstructive airways disease in subjects with unexplained airway symptoms. Subjects and methods: 15 GPs were instructed regarding FEV1 measurements and interpretation of spirometry and received a handheld spirometer. GPs performed office spirometry during or immediately after consultation in adults who presented with unexplained airway symptoms and recorded their diagnoses before and after office spirometry. Patients previously diagnosed with asthma or COPD were excluded. Within one week subjects underwent full spirometric testing in a lung function laboratory. Based on the laboratory test a pulmonologist labelled subjects as 'obstructive' or 'not obstructive'. Sensitivity (Se), specificity (Sp), and Diagnostic Odds Ratio (DOR) were calculated for the GPs' diagnosis of obstructive airways disease before and after office spirometry. The pulmonologists judgements served as 'Gold standard'. Results: 75 subjects were included (29 males). Mean age was 54 (SD 16) years. Initial GP diagnoses were: COPD/bronchitis (39%), asthma (36%), COPD/asthma (9%), and URTI (5%). Mean office spirometry post-BD FEV1 % predicted was 10.5% (SD 11.2) lower than for the laboratory test (p < 0.001). Before office spirometry the GPs' diagnosis of COPD had a Se = 56%, Sp = 53% and DOR = 1.47 (95%CI 1.35; 1.67). After office spirometry these values were Se = 56% en Sp = 76% and DOR = 4.12 (95%CI 2.98; 7.47), respectively. Conclusions: Although office spirometry FEV1 values were significantly lower compared to laboratory values, the higher specificity and Diagnostic Odds Ratio indicate better diagnostic test characteristics of the GPs judgment when office spirometry is added in adults who present with unexplained airway symptoms.

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In primary care, light forms of asthma are most commonly monitored. We found low concordance with the GINA 2002 directives. IC are widely used, but often at incorrect doses. We insist on the importance of classifying asthma according to its gravity in order to prescribe the right treatment.