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Geographic differences in clinical characteristics and management of COPD: the EPOCA study
Authors Miravitlles M , Murio C, Tirado-Conde G, Levy G, Muellerova H, Soriano JB, Ramirez-Venegas A, Ko FW, Canelos-Estrella B, Giugno E, Bergna M, Chérrez I, Anzueto A
Published 5 December 2008 Volume 2008:3(4) Pages 803—814
DOI https://doi.org/10.2147/COPD.S4257
Review by Single anonymous peer review
Peer reviewer comments 2
Marc Miravitlles1, Cristina Murio2, Gema Tirado-Conde1, Gur Levy3, Hana Muellerova4, Joan B Soriano5, Alejandra Ramirez-Venegas6, Fanny WS Ko7, Byron Canelos-Estrella8, Eduardo Giugno9, Miguel Bergna9, Ivan Chérrez10, Antonio Anzueto11
1Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, Spain; 2Secció de Pneumologia, Hospital General de Catalunya, Barcelona, Spain; 3Servicio de Neumonología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela; 4GlaxoSmithKline, Greenford, UK and Research Triangle Park, USA; 5Programa de Epidemiología e Investigación Clínica, Fundación Caubet-CIMERA Bunyola, Illes Balears, Spain; 6Departamento de Investigacion en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México; 7Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, New Territories, Peoples Republic of China; 8Hospital Metropolitano, Universidad Central del Ecuador y Pontificia Universidad Católica del Ecuador, Quito, Ecuador; 9Hospital del Tórax Dr. Antonio Cetrangolo, Vicente López, Buenos Aires, Argentina; 10RESPIRALAB-Hospital Kennedy, Guayaquil, Ecuador; 11Division of Pulmonary and Critical Care Medicine at the South Texas Veterans Health Care System Audie L Murphy Division and the University of Texas Health Science Center, San Antonio, TX USA
Aims: Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines.
Method: This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study.
Results: A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV1 = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV1(%) (r = –0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries.
Conclusions: Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings.
Keywords: COPD, epidemiology, EPOCA, socioeconomics
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