Encuesta a neumonologos sobre el diagnostico y tratamiento de EPOC / Survey of chest physicians regarding COPD diagnosis and treatment

ABSTRACT

A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed). They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria). Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S), and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8%) followed by nebulization (16.5%), dry powder inhalation (13.7%) and oral administration (4.8%). First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC) + short acting beta2-agonists (SABA) (65.5%), AC alone (18.8%), long acting beta2-agonists (LABA) (9.7%), inhaled corticosteroids (IC) (3.5%) and SABA alone (2.8%). Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice antibiotic formulation was beta-lactamics + beta-lactamase inhibitors in 39% of the responders followed by fluorquinolones in 23.7%, macrolides in 17.5% and beta-lactamics in 12.5%. Lastly, 12.7% of COPD patients received long-term domiciliary oxygen therapy. 59.3% of them were prescribed pulmonary rehabilitation, 94.1% vaccination against in...

RESUMEN

Se realizo una encuesta acerca de diagnostico y tratamiento de EPOC a un grupo de 517 especialistasen neumonologia, seleccionados al azar entre los 1121 integrantes de la Asociacion Argentina de Medicina Respiratoria. Se obtuvieron 187 respuestas (36.2%). Atienden en promedio 53.3 pacientes con EPOC/mes, a los cuales definen como leves el 24.2%, moderados el 41.8% y severos el 33.8% (criterios normativos GOLD).El criterio utilizado para el diagnostico de EPOC fue solo clinico en el 2.9%, clinico y espirometria (ESP) en el 23.4%y clinico, ESP y por imagenes en el 73.7%. El 70.1% de los encuestados incluye dentro de la definicion de EPOC al asma cronico de escasa respuesta a broncodilatadores. Solo el 14.1% manifiesta realizar espirometria en cada consulta. La evaluacion de la funcion cardiaca la realizan en EPOC severa por examen clinico (90.6%), electrocardiograma (80.6%) y ecocardiograma (73.8%). El 98.3% de los encuestados afirma que la mayoria de los pacientes son instruidosen la realizacion de maniobras de inhalacion de medicamentos. Eligieron como primera opcion para administrarbroncodilatadores en aerosol (64.8%), nebulizacion (16.5%), polvo (13.7%) y via oral (4.8%). El 65.5% eligio comoprimera opcion de tratamiento cronico a los anticolinergicos (AC) + beta2-agonistas de acción corta (BAAC), 18.8% ACsolos, 9.7% beta2-agonistas de accion larga (BAAL), 3.5% corticoides inhalados (CI) y 2.8% BAAC solos. Los corticoides sistemicos y los antibioticos fueron utilizados en las reagudizaciones severas por el 92.5% y el 70% de los encuestados, respectivamente. En esa situacion, como antibioticos de primera eleccion, fueron elegidos los beta lactamicos + inhibidores de beta-lactamasa por el 39.1% de los encuestados, fluorquinolonas (23.7%), macrolidos (17.4%) y betalactamicos...