¿Qué ha supuesto la Guía Española de la EPOC (GesEPOC) y cómo puede mejorar?

Miravitlles, Marc

doi:10.1016/j.arbres.2015.04.001

Cited by 30 publications

(8 citation statements)

References 13 publications

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“…After three years, this seems to be the right time to test the adherence to this guideline. Despite the admittedly important contribution of GesEPOC to patient evaluation [ 6 ], it seems that the implementation of this guideline is far from optimal. The two main aspects of the guideline, the categorization of patients according to clinical phenotypes and the severity evaluation according to multidimensional BODE or BODEx indexes, are not extremely common in our area.…”

Section: Discussionmentioning

confidence: 99%

“…COPD is a disease of the first magnitude in terms of morbidity and mortality [ 3 ], with a wide prevalence in the population [ 4 ] and a considerable impact on the health system [ 5 , 6 ]. It follows that health care of the patient with COPD should employ the highest quality standards for its potential impact on the lives of patients.…”

Section: Introductionmentioning

confidence: 99%

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Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit

et al. 2016

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ObjectivesPrevious clinical audits of COPD have provided relevant information about medical intervention in exacerbation admissions. The present study aims to evaluate adherence to current guidelines in COPD through a clinical audit.MethodsThis is a pilot clinical audit performed in hospital outpatient respiratory clinics in Andalusia, Spain (eight provinces with more than 8 million inhabitants), including 9 centers (20% of the public centers in the area) between 2013 and 2014. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The performance of the outpatient clinics was benchmarked against three guidance documents available at the time of the audit. The appropriateness of the performance was categorized as excellent (>80%), good (60−80%), adequate (40−59%), inadequate (20−39%), and highly inadequate (<20%).ResultsDuring the audit, 621 clinical records were audited. Adherence to the different guidelines presented a considerable variability among the different participating hospitals, with an excellent or good adherence for symptom recording, MRC or CAT use, smoking status evaluation, spirometry, or bronchodilation therapy. The most outstanding areas for improvement were the use of the BODE index, the monitoring of treatments, the determination of alpha1-antitrypsin, the performance of exercise testing, and vaccination recommendations.ConclusionsThe present study reflects the situation of clinical care for COPD patients in specialized secondary care outpatient clinics. Adherence to clinical guidelines shows considerable variability in outpatient clinics managing COPD patients, and some aspects of the clinical care can clearly be improved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit

et al. 2016

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“…The evaluation of clinical phenotypes in the management of COPD is a novel approach initially proposed in the Spanish COPD guidelines (GesEPOC) 4 and subsequently adopted by other countries. 31 In this context, it will be important to explore how these phenotypes can be used in clinical practice and how they may influence treatment selection.…”

Section: Discussionmentioning

confidence: 99%

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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“…In fact, the study was aimed to demonstrate that the late events taking place in the skeletal muscle of patients with cachexia of respiratory etiology (either COPD or LC) shared similar molecular and cellular profiles regardless of the underlying condition [4]. On the other hand, it has also been repeatedly demonstrated that COPD per se, especially lung emphysema, is a major risk factor for LC and that the two conditions often coexist in the same patients [35–41]. Thus, more severe muscle wasting may occur in patients with LC and underlying emphysema.…”

Section: Introductionmentioning

confidence: 99%

Phenotypic and metabolic features of mouse diaphragm and gastrocnemius muscles in chronic lung carcinogenesis: influence of underlying emphysema

et al. 2016

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BackgroundMuscle wasting negatively impacts the progress of chronic diseases such as lung cancer (LC) and emphysema, which are in turn interrelated.ObjectivesWe hypothesized that muscle atrophy and body weight loss may develop in an experimental mouse model of lung carcinogenesis, that the profile of alterations in muscle fiber phenotype (fiber type composition and morphometry, muscle structural alterations, and nuclear apoptosis), and in muscle metabolism are similar in both respiratory and limb muscles of the tumor-bearing mice, and that the presence of underlying emphysema may influence those events.MethodsDiaphragm and gastrocnemius muscles of mice with urethane-induced lung cancer (LC-U) with and without elastase-induced emphysema (E–U) and non-exposed controls (N = 8/group) were studied: fiber type composition, morphometry, muscle abnormalities, apoptotic nuclei (immunohistochemistry), and proteolytic and autophagy markers (immunoblotting) at 20- and 35-week exposure times. In the latter cohort, structural contractile proteins, creatine kinase (CK), peroxisome proliferator-activated receptor (PPAR) expression, oxidative stress, and inflammation were also measured. Body and muscle weights were quantified (baseline, during follow-up, and sacrifice).ResultsCompared to controls, in U and E–U mice, whole body, diaphragm and gastrocnemius weights were reduced. Additionally, both in diaphragm and gastrocnemius, muscle fiber cross-sectional areas were smaller, structural abnormalities, autophagy and apoptotic nuclei were increased, while levels of actin, myosin, CK, PPARs, and antioxidants were decreased, and muscle proteolytic markers did not vary among groups.ConclusionsIn this model of lung carcinogenesis with and without emphysema, reduced body weight gain and muscle atrophy were observed in respiratory and limb muscles of mice after 20- and 35-week exposure times most likely through increased nuclear apoptosis and autophagy. Underlying emphysema induced a larger reduction in the size of slow- and fast-twitch fibers in the diaphragm of U and E–U mice probably as a result of the greater inspiratory burden imposed onto this muscle.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-1003-9) contains supplementary material, which is available to authorized users.

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¿Qué ha supuesto la Guía Española de la EPOC (GesEPOC) y cómo puede mejorar?

Cited by 30 publications

References 13 publications

Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit

Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit

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

Phenotypic and metabolic features of mouse diaphragm and gastrocnemius muscles in chronic lung carcinogenesis: influence of underlying emphysema

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