Hospitalized patients with COPD: analysis of prior
                  treatment

Giacomelli, Irai Luis; Steidle, Leila John Marques; Moreira, Frederico Fernandes; Meyer, Igor Varela; Souza, Ricardo Goetten; Pincelli, Mariângela Pimentel

doi:10.1590/S1806-37132014000300005

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Jornal Brasileiro de Pneumologia

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Original Articles • J. bras. pneumol. 40 (03) • May-Jun 2014 • https://doi.org/10.1590/S1806-37132014000300005 copy

Hospitalized patients with COPD: analysis of prior treatment^* * Study carried out at the Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, and at the Nereu Ramos Hospital, Florianópolis, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment.

Methods:

This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook).

Results:

In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment.

Conclusions:

The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.

Pulmonary disease, chronic obstructive; Pulmonary disease, chronic obstructive; Clinical protocols

Variable		n	%
Gender	Male	33	66
Age, years	≤ 64	17	34
Age, years	≥ 65	33	66
Schooling, years	≤ 8	45	90
Schooling, years	≥ 9	5	10
Number of times the national minimum wage/number of people	≤ 1	31	62
Number of times the national minimum wage/number of people	> 1	19	38
Occupational status	Not retired	17	34
Occupational status	Retired	33	66
Body mass index, kg/m²	< 18.5	5	10
	18.5-24.9	22	44
	25.0-29.9	14	28
	> 30.0	9	18
Smoking status	Smoking	14	28
	Former smoker	33	66
	Passive smoker	3	06
Duration of dyspnea, years	< 10	19	38
Duration of dyspnea, years	≥ 10	31	62
Physician-diagnosed emphysema, bronchitis, or COPD	Yes	47	94
2011 GOLD classification	A	2	04
	B	10	20
	C	5	10
	D	33	66
CAB classification (spirometry)	Mild	1	02
	Moderate	17	34
	Severe	26	52
	Very severe	6	12

Variable	n/N	%
Having quit smoking	33/47	70
Having been advised by a physician to quit smoking	36/47	78
Having received influenza vaccination	40/50	80
Having been advised by a physician to receive influenza vaccination	16/50	32
Having received pneumococcal vaccination	14/50	28
Having been advised by a physician to receive pneumococcal vaccination	13/50	26
Being on home oxygen therapy	8/50	16
Undergoing pulmonary rehabilitation (GOLD categories B, C, and D)	3/48	6.5

Classification	Category	Patients receiving inappropriate treatment	%
Classification	Category	(n/N)	%
2011 GOLD	A	2/2	100
	B	9/10	90
	C	3/5	60
	D	11/33	33
	Total	25/50	50
CAB	Mild	1/1	100
	Moderate	15/17	88
	Severe	18/26	69
	Very severe	3/6	50
	Total	37/50	74

Categories	Patients (n)	SABA	SAA	SABA + SAA	LABA	LAA	LABA + LAA	IC	LABA + IC	LAA + IC	LABA + LAA + IC
A	2	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	1 (50)	0 (0)	0 (0)
B	10	2 (20)	0 (0)	3 (30)	1 (10)	0 (0)	0 (0)	0 (0)	1 (10)	0 (0)	3 (30)
C	5	1 (20)	0 (0)	0 (0)	0 (0)	0 (0)	1 (20)	0 (0)	1 (20)	0 (0)	1 (20)
D	33	16 (48)	6 (2)	7 (21)	1 (3)	2 (6)	1 (3)	2 (6)	4 (12)	2 (6)	13 (39)
Total	50	19 (38)	4 (2)	10 (20)	2 (4)	2 (4)	2 (4)	2 (4)	7 (14)	2 (4)	17 (34)

Variable		Treatmenta		p	OR	95% CI
Variable		inappropriate	appropriate	p	OR	95% CI
Per capita income, number of times the national minimum wage	≤ 1	14 (28)	6 (12)	0.021	4.03	1.20-13.53
	> 1	11 (22)	19 (38)	0.021	4.03	1.20-13.53
Schooling, years	≤ 8	25 (50)	20 (40)	0.018	1.25	1.03-1.52
Schooling, years	> 8	0 (0)	5 (10)	0.018	1.25	1.03-1.52
Physician-diagnosed emphysema	Yes	11 (22)	21 (42)	0.003	0.15	0.04-0.57
Physician-diagnosed emphysema	No	14 (28)	4 (8)	0.003	0.15	0.04-0.57
GOLD category	A or B	11 (22)	1 (2)	0.001	18.86	2.20-161.99
GOLD category	C or D	14 (28)	24 (48)	0.001	18.86	2.20-161.99

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] Correspondence to: Irai Luis Giacomelli Departamento de Clínica Médica, Hospital Universitário da UFSC Campus Universitário, Trindade, CEP 88040-970, Florianópolis, SC, Brasil Tel/Fax: 55 48 3233-2152. E-mail: iraigiacomelli@gmail.com

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Hospitalized patients with COPD: analysis of prior treatment* * Study carried out at the Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, and at the Nereu Ramos Hospital, Florianópolis, Brazil.

Objective:

Methods:

Results:

Conclusions:

Hospitalized patients with COPD: analysis of prior treatment^* * Study carried out at the Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, and at the Nereu Ramos Hospital, Florianópolis, Brazil.