Pulmonologists' Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
Por:
Miravitlles, M, Gonzalez-Torralba, F, Represas-Represas, C, Pomares, X, Marquez-Martin, E, Gonzalez, C, Amado, C, Forne, C, Alonso, S, Alcazar, B, Barrecheguren, M, Mirete, J and Naval, E
Publicada:
1 ene 2022
Resumen:
Introduction: Identifying the variables that guide decision-making in relation to the use of inhaled corticosteroids (ICS) can contribute to the appropriate use of these drugs. The objective of this study was to identify the clinical variables that physicians consider most relevant for prescribing or withdrawing ICS in COPD.Methods: A cross-sectional survey was conducted in Spain from November 2020 to May 2021. Therapeutic decisions on the use of ICS in 11 hypothetical COPD patient profiles were collected using an online survey answered by specialists with experience in the management of patients with COPD. Mixed-effects logistic regression was used to analyze the impact of patients' characteristics in the therapeutic decision for prescribing ICS or proceeding to its withdrawal.Results: A total of 74 pulmonologists agreed to collaborate in the survey and answered the questionnaire. The results showed great variability, with only 2 profiles achieving consensus for starting or withdrawing the treatment. The frequency and severity of exacerbations influenced the decision to prescribe ICS in a dose-response fashion (1 exacerbation odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.02 to 3.43, two exacerbations OR = 11.6, 95% CI: 4.47 to 30.2 and three OR = 123, 95% CI: 25 to 601). Similarly, increasing blood eosinophils and history of asthma were associated with ICS use. On the other hand, pneumonia reduced the probability of initiating treatment with ICS (OR = 0.54 [0.29 to 0.98]). Lung function and dyspnea degree did not influence the clinician's therapeutic decision. The results for withdrawal of ICS were similar but in the opposite direction.Conclusion: In accordance with guidelines, exacerbations, blood eosinophils and history of asthma or pneumonia are the factors considered by pulmonologist for the indication or withdrawal of ICS. However, the agreement in prescription or withdrawal of ICS when confronted with hypothetical cases is very low, suggesting a great variability in clinical practice.
Filiaciones:
Miravitlles, M:
Hosp Universitari Vall dHebron, Vall dHebron Barcelona Hosp Campus, Vall dHebron Inst Recerca VHIR, Pneumol Dept, Barcelona, Spain
ISCIII, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Universitari Vall dHebron, Pneumol Dept, Marc Miravitlles, P Vall dHebron 119-129, Barcelona 08035, Spain
Gonzalez-Torralba, F:
Hosp Univ Tajo, Pneumol Dept, Aranjuez, Spain
Represas-Represas, C:
Hosp Alvaro Cunqueiro, Pneumol Dept, Vigo, Spain
Pomares, X:
ISCIII, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Corporacio Sanitaria Parc Tauli, Pneumol Dept, Sabadell, Spain
Hosp Univ Ribera, Pneumol Dept, Alzira, Spain
Marquez-Martin, E:
ISCIII, CIBER Enfermedades Respiratorias CIBERES, Madrid, Spain
Hosp Univ Virgen Rocio, Med Surg Unit Resp Dis, Seville, Spain
Gonzalez, C:
Hosp Clin Valencia, Pneumol Dept, Valencia, Spain
Amado, C:
Hosp Univ Marques Valdecilla, Pneumol Dept, Santander, Spain
Forne, C:
Hosp Universitari Vall dHebron, Vall dHebron Barcelona Hosp Campus, Vall dHebron Inst Recerca VHIR, Pneumol Dept, Barcelona, Spain
Heorfy Consulting, Lleida, Spain
Univ Lleida, Basic Med Sci Dept, Lleida, Spain
Alonso, S:
Hosp Univ Torrejon, Pneumol Dept, Torrejon De Ardoz, Spain
Alcazar, B:
Hosp Univ Virgen Nieves, Pneumol Dept, Granada, Spain
Barrecheguren, M:
Hosp Universitari Vall dHebron, Vall dHebron Barcelona Hosp Campus, Vall dHebron Inst Recerca VHIR, Pneumol Dept, Barcelona, Spain
Mirete, J:
GOC Hlth Consulting, Sci Dept, Barcelona, Spain
Green Published, gold
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