Valuation of diagnosis and treatment of patients with Chronic Obstructive Pulmonary Disease on discharge
DOI:
https://doi.org/10.18004/Keywords:
pulmonary disease, chronic obstructive, herapeutics, classification, ParaguayAbstract
Introduction: Chronic obstructive pulmonary disease (COPD) affects millions of people around the world; and globally it represents the fourth cause of death, although a preventable one. The annual cost of the disease and the money spent during the exacerbation can represent a catastrophic expense for the family and society; this makes the ambulatory treatment of the COPD of the outmost importance. Objectives: to evaluate the classification of the diagnosis, the adequacy of treatment, and the non-pharmacologic recommendations. As specific aim: to know smokers, main signs and symptoms, and to classify according to severity to those diagnosed by spirometry on discharge from hospital in patients with COPD. Material and methods: this study was observational, descriptive, and retrospective, with analytic component. Sixty two patients with COPD on discharge were included of a teaching hospital (years 2004 to 2008). Results: 46,8% of patients spirometry was done. The drugs used in decreasing frequency were short acting 2 agonists 96,8%, anticholinergics 93,5%, long acting 2 agonists 46,8%, long acting inhaled steroids 46,8%, oral steroids 25,8%, intravenous steroids 6,5%, short acting inhaled steroids 4,8%, and mucolitics 1,64%; non pharmacologic recommendations 24,2%. In relation to risk factors 87,1% were smokers or previous smokers. Between patients submitted to spirometry, the average age was 68,97 years, 79,3% were males, living the majority in the Central Region of the country; 89,7% were smokers or ex smokers with the following signs and symptoms: dyspnea 89,7%, cough 72,4%, sputum production 62,1%, wheezing 51,7%. Severity of illness according to grades were I (Mild) 7%, II (Moderate) 24.1%, III (Severe) 31% and IV (Very severe) 37,9%. Conclusions: in 47% of patients diagnosed as COPD spirometry was done. The more used drugs were: short acting 2 agonists, short acting anticholinergics, followed by inhaled oral steroids and others. The non pharmacologic recommendations were rare. The more frequent signs and symptoms were dyspnea, cough, sputum production and wheezing. The majority was in category of severe or very severe.
References
1. Global Initiative for Chronic Obstructive Lung Disease. Estrategia global para el diagnóstico, tratamiento y prevención de la enfermedad pulmonar obstructiva crónica: GOLD (Resumen); Bethesda. MD: National Institutes of Healht, National Heart, Lung and Blood Institute; 2006.
2. Peces-Barba G, Barbera JA, Agusti A, Casanova C, Casas A, Izquierdo JL, et al. Guía clínica SEPARALAT de diagnóstico y tratamiento de la EPOC. Arch Bronconeumol. 2008; 44(5):271-81.
3. Muiño A, López Varela MV, Menezes AM. Prevalencia de la enfermedad pulmonar obstructiva crónica y sus principales factores de riesgo: proyecto PLATINO en Montevideo. Rev Med Uruguay 2005; 21:37-48.
4. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397- 412.
5. Celli B. Update on the Management of COPD. Chest 2008; 133: 1451-1462
6. López MV, Muiño A, Pérez R, Jardim JR, Tálamo C, Montes de Oca M, et al. Tratamiento de la
EPOC en 5 ciudades de América Latina: estudio PLATINO. Arch Bronconeumol. 2008; 44(2):58-64.
7. Navarro F. Efecto de las combinaciones salbutamol- ipratropio y salbutamol- tiotropio inhalados y teofilina vía oral en pacientes con EPOC. Análisis de costo/efectividad. Rev Inst Nal Enf Resp Mex 2006 Abril - Junio; 19(2):122-26.
8. Ministerio de Salud Pública y Bienestar Social. Defunciones generales según causas y grupos de edad. Paraguay, 2004-08. Asunción: El Ministerio; 2009
9. Enfermedad Pulmonar Obstructiva Crónica (EPOC). 1er.Consenso Paraguayo: aspectos principales. Asunción, 2000.
10. Flores S, Alvarez C, Ruiz J, Prado E, Gil MV. Análisis del tratamiento tras el egreso hospitalario en pacientes con enfermedad pulmonar obstructiva crónica. Rev Inst Nal Enf Resp Mex 2007 Abril - Junio; 20(2):113-18.
11. Global Initiative for Chronic Obstructive Lung Disease. Workshop Report, Global Strategy for Diagnosis, Management, and Prevention of COPD. Update Sept. 2005. Bethesda. MD: National Institutes of Healht, National Heart, Lung and Blood Institute; 2005.
12. Pauwels R. Global initiative for chronic obstructive lung diseases (GOLD): time to act. Eur Respir J 2001; 18: 901-2.
13. INER, Sociedad Mexicana de Neumología y Cirugía del Tórax. Segundo Consenso Mexicano para el Diagnostico y Tratamiento de la EPOC. Edición especial. Cuernavaca: El INER y la SMN y CT; 2002.
14. Rudolf M. The reality of drug use in COPD: the European perspective. Chest 2000; 117(2 Suppl):29-32.
15. Instituto Nacional de Epidemiología "Dr. Juan H. Jara" (Argentina). Los métodos de investigación epidemiológica. Mar del Plata: El Instituto; 1998. (Módulo 4).
16. Pineda EB, Alvarado EL, Canales FH. Metodología de la investigación: manual para el desarrollo de personal de salud. 2a. ed. Washington: Organización Panamericana de la Salud/ Organización Mundial de la Salud; 1994.
17. Instituto Nacional de Epidemiología "Dr. Juan H. Jara" (Argentina). Epidemiología, usos y
perspectivas. Mar del Plata: El Instituto; 1998. (Módulo 1).
18. Instituto Nacional de Epidemiología " Dr. Juan H. Jara " (Argentina). Las medidas de efecto y de impacto en epidemiología. Mar del Plata: El Instituto; 1 998.( Módulo 5)
19. Miravitlles M, Murio C, Guerrero T, Segú JL. Tratamiento de la bronquitis crónica y la EPOC en atención primaria. Arch Bronconeumol 1999; 35:173-8.
20. Miravitlles M, Mayordomo M, Artés M, Sánchez-Agudo L, Nicolau F, Segú JL. On behalf of the EOLO Group. Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. Respir Med 1999; 93:173-9.
