Medical Care According to Risk Level and Adaptation to Spanish COPD Guidelines (Gesepoc): The Epoconsul Study

Arch Bronconeumol (Engl Ed). 2018 May;54(5):270-279. doi: 10.1016/j.arbres.2017.11.015. Epub 2018 Feb 1.
[Article in English, Spanish]

Abstract

Introduction: EPOCONSUL is the first national audit to analyze medical care for COPD in pulmonology departments in Spain. The main objective was to perform a retrospective analysis to determine the distribution of GesEPOC 2017 COPD risk levels and to evaluate clinical activity according to the new recommendations.

Material and methods: This is a cross-sectional clinical audit in which consecutive COPD cases were recruited over one year. The study evaluated risk and clinical phenotype according to GesEPOC 2017, and their correlation with the clinical interventions employed.

Results: The most common risk category was high risk (79.8% versus 20.2%; p < 0.001), characterized by a higher level of severity on BODE and BODEx indexes, and a higher comorbidity burden. The most common phenotype was non-exacerbator. The most commonly used treatment in low-risk patients was bronchodilator monotherapy (34.8%) and triple therapy in high-risk patients (53.7%). High risk was most frequently characterized by phenotype (57.6% versus 52%; p = 0.014) and pulmonary function test results: lung volume (47.7% versus 35.8%; p < 0.001), lung diffusion (51.4% versus 42.1%; p < 0.001) and walk test (37.8% versus 15.8%; p < 0.001).

Conclusions: Most patients treated in pulmonology departments were high-risk and non-exacerbator phenotype. Clinical interventions differed according to risk level and mainly followed GesEPOC recommendations, although there is significant room for improvement.

Keywords: Chronic obstructive pulmonary disease; Clinical phenotype; Enfermedad pulmonar obstructiva crónica; Fenotipo clínico; GesEPOC; Nivel de riesgo; Risk level.

MeSH terms

  • Aged
  • Bronchodilator Agents / therapeutic use
  • Clinical Audit
  • Cross-Sectional Studies
  • Disease Management
  • Female
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • National Health Programs
  • Oxygen Inhalation Therapy
  • Phenotype
  • Practice Guidelines as Topic
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Respiratory Function Tests
  • Respiratory Therapy
  • Retrospective Studies
  • Risk Assessment
  • Spain

Substances

  • Bronchodilator Agents