Clinical Management of COPD in a Real-World Setting. A Big Data Analysis. / Manejo clínico de la EPOC en situación de vida real. Análisis a partir de big data.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the quality of diagnosis and treatment of COPD using Big Data methodology on the Savana Manager 2.1 clinical platform. MATERIALS AND METHODS: A total of 59,369 patients with a diagnosis of COPD were included from a population of 1,219,749 adults over 40 years of age. RESULTS: In total, 78% were men. Spirometry data were available for only 26,453 (43.5%) subjects. Disease severity was classified in 18,172 patients 4,396 mild, 7,100 moderate, and 6,676 severe, although only 27%, 34%, and 28%, respectively, presented obstructive spirometry. The clinical management of COPD is mainly the responsibility of the primary care and pulmonology departments, while internal medicine and, to a lesser extent, geriatrics also participate. Drug treatment was based on bronchodilators and inhaled corticosteroids (ICS). A marked decline in the use of long-acting beta-2 agonists (LABA) in monotherapy and a slight reduction in ICS/LABA combinations, associated with a LAMA in 74% of cases, was observed. All-cause in-hospital mortality among the overall population was 5.6% compared to 1% of the general population older than 40 years. In total, 35% were admitted to hospital, with an average stay of 6.6 days and a rate of hospital mortality in this group of 10.74%. DISCUSSION: This study identifies the main features of an unselected COPD population and the major errors made in the management of the disease.