PURPOSE: The aim of the study was to describe the prescribing practices of general practitioners in Mexico in subjects at risk or already diagnosed with chronic obstructive pulmonary disease (COPD)
METHODS: Individuals 40 years or older with known risk factors for COPD (smoking, exposure to indoor pollution from biomass smoke and occupational dusts and chemicals) whether symptomatic or not, were referred by first-contact physicians in 27 Mexican cities. After obtaining written informed consent they were invited to answer the Spanish version of the PLATINO questionnaire and undergo pre and postbronchodilator spirometry. We used the GOLD definition for COPD. The analysis is limited to the prescribing practices for patients in stages III and IV where there is an established consensus on optimal treatment.
RESULTS: 2,293 subjects were included; 472 (20.6%) had a FEV1/FVC <70%; 123 (26.1%) were classified as stage III and 36 (7.6%) as stage IV COPD. 97 patients(79%)in stage III and 33(92%) in stage IV where receiving treatment for their respiratory disease (p=0.13). Only 39% of stage III and 22% of stage IV patients were receiving inhaled steroids (IE) combined with some long acting adrenergic bronchodilator (LABA), while 8.1% (stage III)and 11.1% (stage IV; p=0.8) were receiving long acting anticolinergic bronchodilators (LAMA)as monotherapy. 8.9% of stage III and 13.8% of stage IV (p=0.57) were receiving treatment with triple therapy (IE+LABA+LAMA). Out of 763 active smokers at the time of the interview, 71 (9.3%) had received some type of intervention (behavioral or pharmacological). Fifty-seven (7.4%) had received a prescription as an aid in their smoking cessation efforts. Nicotine substitutes were prescribed in 34 cases (4.4% of total current smokers), bupropion in 11(1.4%) and varenicline in 12(1.6%).
CONCLUSIONS: Despite the existence of evidence based guidelines only about a third of primary health care COPD are receiving state-of-the-art treatment. Even worst, only one in thirteen active smokers had received a prescription for a pharmacologic cessation aid.
CLINICAL IMPLICATIONS: Despite the existence of national and international evidence-based clinical guidelines for the treatment of COPD, patients are inadequately treated. More medical training on the subject is urgently needed
DISCLOSURE: The following authors have nothing to disclose: Rafael Laniado-Laborin, Adrian Rendon, Otto Bauerle
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