[Are health district prevalence studies useful in family practice? Report of a case: chronic obstructive pulmonary disease]. / ¿Los estudios de prevalencia de zona básica de salud tienen sentido en medicina familiar y comunitaria? A propósito de un caso: la enfermedad pulmonar obstructiva crónica.

ABSTRACT

OBJECTIVE: To determine the prevalence of COPD and smoking in a Health District, to correlate real, registered, and extrapolated morbidity. To determine personal, family and social profiles. To determine the validity of the lung function questionnaire. DESIGN: Prevalence study. LOCATION Urban District Health. PARTICIPANTS: Random selection of 233 people aged 40-75years. MAIN MEASUREMENTS Age, sex, pack/years, spirometry, pulse-oximetry, medication, income. TESTS Fagerström, Richmond, MOS, APGAR, and lung function. RESULTS: Mean age was 53.7+7.6years, with 57.9% women. Registered morbidity for COPD 1.2% (0.5-3.9%). Prevalence 4.7% (1.5% female, 9.2% male), extrapolated prevalence 10.2%. Registered morbidity for Smoking 10.7% (1-19.4%); prevalence 18.5% (20% female, 16.3% male), extrapolated prevalence 23.95%. Lung function questionnaire positive likelihood ratio 3.18; negative 0.1. High probability of COPD (59.5%) in >30 packs/year smokers. Smokers consume a mean of 20.8 packs/year. Women showed higher physical dependence (36% versus 21%). More probability of achieving successful smoking cessation in men (57.1% versus 44%). There was 14.7% perceived family dysfunction; 6.9% have a low global index of social support, and 9.1% in COPD subjects. More than two-thirds (70%) of COPD patients had never been hospitalized. There were 10% polymedicated patients compared to 60% in identified COPDs. CONCLUSIONS: Prevalence of COPD and smoking (indicator of avoidable morbidity attributable to primary care) are substantially lower than the reference data. The lung function questionnaire is valid. There was evidence of inter-professional variability. Women smoke more, are more dependent and are less motivated to quit. Their family and social perception is worse. These investigations are essentials for community intervention and operational planning.