[Perceptions of family doctors, pulmonologists and allergists on the approach to patients with chronic cough. Results of an anonymous survey]. / Percepciones de médicos de familia, neumólogos y alergólogos sobre el abordaje de los pacientes con tos crónica. Resultados de una encuesta anónima.

OBJECTIVE: To understand the perception of family doctors, pulmonologists and allergists about the current approach to chronic cough and its impact on patients' quality of life. MATERIAL AND METHODS: Cross-sectional and anonymous survey disseminated through the scientific societies SEAIC, SEMERGEN, semFYC, SEMG and SEPAR. The participants were 620 family doctors, 92 pulmonologists and 62 allergists. A descriptive analysis of the answers was conducted. Response percentages, medians and interquartile intervals were presented. The differences in the percentages between specialties were evaluated with the chi-square. RESULTS: Only half of the respondents chose a duration greater than 8 weeks as a criterion for diagnosing chronic cough, and less than half considered refractory/unexplained chronic cough a disease in itself. Family doctors perceived that chronic cough had less impact on patients than did pulmonologists or allergists. After a diagnosis of refractory/unexplained chronic cough, all 3specialties considered the most common approach to be to initiate treatment and to do the follow-up of the patient themselves. Most stated that they had no protocols for managing chronic cough, and more than 90% considered these to be necessary. CONCLUSIONS: The management of patients with chronic cough by family doctors, pulmonologists or allergists seems to be heterogeneous. There is a need for protocols that standardise diagnosis, referral and treatment criteria to optimise patients' management and reduce the impact of chronic cough.

Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC) 2017: tratamiento farmacológico en fase estable / Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017: pharmacological treatment of stable phase

La enfermedad pulmonar obstructiva crónica (EPOC) presenta una gran heterogeneidad clínica, por lo que su tratamiento se debe individualizar según el nivel de riesgo y el fenotipo. La Guía española de la EPOC (GesEPOC) estableció por primera vez en 2012 unas pautas de tratamiento farmacológico basadas en fenotipos clínicos. Estas pautas han sido adoptadas posteriormente por otras normativas nacionales, y han sido respaldadas por nuevas evidencias publicadas desde entonces. En esta actualización 2017 se ha sustituido la clasificación de gravedad inicial por una clasificación de riesgo mucho más sencilla (bajo o alto riesgo), basándose en la función pulmonar, el grado de disnea y la historia de agudizaciones, y se recomienda la determinación del fenotipo clínico únicamente en pacientes de alto riesgo. Se mantienen los mismos fenotipos clínicos: no agudizador, EPOC-asma (ACO), agudizador con enfisema y agudizador con bronquitis crónica. La base del tratamiento farmacológico de la EPOC es la broncodilatación, y también es el único tratamiento recomendado en pacientes de bajo riesgo. En los pacientes con alto riesgo se añadirán diversos fármacos a los broncodilatadores según el fenotipo clínico. GesEPOC supone una aproximación al tratamiento de la EPOC más individualizado según las características clínicas de los pacientes y su nivel de riesgo o de complejidad.(AU)

The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype. In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes. These regimens were subsequently adopted by other national guidelines, and since then, have been backed up by new evidence. In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients. The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with bronchitis. Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients. High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype. GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity.(AU)