Management of COPD within the Brazilian Unified Health Care System in the state of Bahia: an analysis of real-life medication use patterns

Abstract

Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient’s pharmacological treatment was evaluated by comparing the patient’s current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.

Evidence that justifies reviewing policies of access to medicines for chronic obstructive pulmonary disease in the Brazilian Public Health System

“…(4) Moreover, real life evidence suggests many COPD patients are inappropriately treated at SUS. (5,6) Julian et al, analyzed the standard treatment of the disease in a national sample of 301,975 patients, in 2017, and found the combined use of ICS/LABA in approximately 92% of patients. (5) The authors drew attention to overtreatment of the disease for this population, due to excessive use of ICS, which can increase the costs of treatment as well as the risks of adverse events.…”

Avaliação clínica da gravidade em pacientes portadores de doença pulmonar obstrutiva crônica (DPOC) atendidos no CEMEC – CESUPA / Clinical evaluation of gravity in patients with chronic obstructive pulmonary disease (COPD) care at CEMEC - CESUPA

“…As tabelas foram construídas com as ferramentas do software Microsoft Word® e os gráficos com o programa GraphPad Prism versão 8.00. Todos os testes foram executados com o auxílio do programa BioEstat® 5.5 (Ayres M et al, 2015) ou GraphPad Prism versão 8.00, sendo que resultados com p ≤ 0.05 (bilateral) foram considerados estatisticamente significativos13,14 .…”

COPD: more treatment will translate to better breathing. Will it?

“…In this issue of the JBP, Pinto et al 4 demonstrate, with great elegance, the regrettable state of COPD treatment in the public health care system in Brazil. Theirs was a cross-sectional study involving patients diagnosed, on the basis of the clinical and spirometric findings, with moderate to severe COPD.…”

“…All of the patients were referred from the SUS-affiliated Bahia State Public Health Care Network to a referral outpatient clinic. The authors demonstrated the reality of the SUS, emphasizing that the approach differs among states, 4 because it depends heavily on the economic condition, although there have been attempts by several state societies to sensitize managers to the need to create treatment protocols for patients with COPD.…”

“…Pinto et al 4 included 383 patients, classified by risk of exacerbation and severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (risk group A, B, C, or D) and the Brazilian National Ministry of Health criteria (moderate, severe, or very severe), respectively. The authors questioned the patients about the use of COPD medications, subsequently assessing the appropriateness of the treatment (to identify undertreatment or overtreatment) in relation to national and international guidelines.…”