Misdiagnosis of patients receiving inhaled therapies in primary care

Izquierdo, José Luis; Martín, Antonio; Lucas, Pilar de; Rodríguez-González-Moro, José Miguel; Almonacid, Carlos; Paravisini, Alexandra

doi:10.2147/copd.s11123

Cited by 40 publications

(12 citation statements)

References 12 publications

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“…Previous observational studies have described the prescription profile in different clinical settings and geographic areas. 9 , 18 – 20 These studies described the prescription patterns; however, the present analysis indicates what type of change the doctors made and the determinants of these changes.…”

Section: Discussionmentioning

confidence: 81%

Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

Lόpez-Campos

Arranz

Acuña

et al. 2016

COPD

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IntroductionThis study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment.MethodsThis study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation.ResultsThe present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99 patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1 second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment.ConclusionThe majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up.

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Section: Discussionmentioning

confidence: 81%

Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

Lόpez-Campos

Arranz

Acuña

et al. 2016

COPD

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“…14 The CCQ is used to measure COPD health status, and it contains 10 questions. The total score (range 0–6) can be distributed between ‘stable’ (<1), ‘not entirely stable’, 1 , 2 ‘unstable’ 2 , 3 and ‘very unstable’ (⩾3). This questionnaire contains three subdomains with four questions about functional status, four questions about symptoms and two questions about mental status.…”

Section: Methodsmentioning

confidence: 99%

“…1 In the Netherlands, 60 to 80% of all asthma and COPD patients are treated by their general practitioner (GP), and patients are only referred to the pulmonologist in case of severe uncontrolled asthma or severe COPD. 2 Misdiagnosis and underdiagnosis are common, 3–5 as asthma and COPD overlap in symptoms, whereas their treatments are different. 6 Some patients have both asthma and COPD, the so-called overlap syndrome, which can be described as (partly) reversible but progressive deterioration in lung function, often combined with a history of smoking and previous diagnosis of asthma and/or allergies.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and effectiveness of an Asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results

Metting

Kocks

et al. 2015

npj Prim Care Resp Med

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Background:In 2007, an Asthma/chronic obstructive pulmonary disease (COPD) (AC) service was implemented in the North of the Netherlands to support General Practitioners (GPs) by providing advice from pulmonologists on a systematic basis.Aims:To evaluate the feasibility and effectiveness of this service on patient-related outcomes.Methods:We report baseline data on 11,401 patients and follow-up data from 2,556 patients. GPs can refer all patients with possible obstructive airway disease (OAD) to the service, which is conducted by the local laboratory. Patients are assessed in the laboratory using questionnaires and spirometry. Pulmonologists inspect the data through the internet and send the GP diagnosis and management advice.Results:A total of 11,401 patients were assessed by the service, covering almost 60% of all adult patients with projected asthma or COPD in the area. In all, 46% (n=5,268) of the patients were diagnosed with asthma, 18% (n=2,019) with COPD and 7% (n=788) with the overlap syndrome. A total of 740 (7%) patients were followed up after 3 months because the GP advised them to change medication. In this group, the proportion of unstable COPD patients (Clinical COPD Questionnaire (CCQ)⩾1) decreased from 63% (n=92) at baseline to 49% (n=72). The proportion of patients with uncontrolled asthma (Asthma Control Questionnaire (ACQ)⩾1.5) decreased from 41% (n=204) to 23% (n=115). In all, 938 (8%) patients were followed up after 12 months. From these patients, the proportion of unstable COPD patients (CCQ⩾1) decreased from 47% (n=115) to 44% (n=107). The proportion of patients with uncontrolled asthma (ACQ⩾1.5) decreased from 16% (n=95) to 14% (n=85).Conclusion:The AC service assessed a considerable proportion of patients with OAD in the area, improved patients’ outcomes, and is considered to be feasible and effective.

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“… 7–14 In most industrialised countries, it is estimated that ~40% of patients diagnosed with COPD are candidates for ICS according to the GOLD criteria, 15 , 16 whereas prescribing rates can exceed 80%. 17 This frequent prescription of ICS in COPD patients who are unlikely to benefit increases the number of patients at risk of adverse effects, extensively reviewed previously. 18–23 Therefore, it is worth considering whether and how non-recommended ICS treatment can be withdrawn safely.…”

Section: Introductionmentioning

confidence: 99%

Appropriate use of inhaled corticosteroids in COPD: the candidates for safe withdrawal

Yawn

Suissa

Rossi

2016

npj Prim Care Resp Med

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International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit. Given the evidence of the risks associated with ICS and the limited indications for their use, there is interest in understanding the effects of withdrawing ICS when prescribed inappropriately. In this review, we discuss the findings of large ICS withdrawal trials, with primary focus on the more recent trials using active comparators. Data from these trials indicate that ICS may be withdrawn without adverse impact on exacerbation risk and patient-reported outcomes in patients with moderate COPD and no history of frequent exacerbations. Considering the safety concerns associated with ICS use, these medications should be withdrawn in patients for whom they are not recommended, while maintaining adequate bronchodilator therapy.

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Misdiagnosis of patients receiving inhaled therapies in primary care

Cited by 40 publications

References 12 publications

Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

Feasibility and effectiveness of an Asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results

Appropriate use of inhaled corticosteroids in COPD: the candidates for safe withdrawal

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