Respiratory medication use in primary care among COPD subjects in four Latin American countries

• Published in: The international journal of tuberculosis and lung disease Vol. 21; no. 4; pp. 458 - 465
• Main Authors: Jardim, J. R., Stirbulov, R., Moreno, D., Zabert, G., Lopez-Varela, M. V., Montes de Oca, M.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.04.2017
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Bronchodilator Agents - administration & dosage; Case Finding; COPD; Female; Forced Expiratory Volume; Humans; Latin America; Male; Middle Aged; Mycobacterium; Poisson Distribution; Primary Care; Primary Health Care; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Puma; Spirometry; Treatment; Vital Capacity
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.16.0633

OBJECTIVES: To assess respiratory medications used, factors predicting treatment and patterns of corticosteroid (CS) use in primary care in Latin America among chronic obstructive pulmonary disease (COPD) patients.METHODS: COPD was defined as post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) < 0.70 or previous medical diagnosis. To determine factors associated with respiratory medication use, crude and adjusted Poisson regression models were performed.RESULTS: Of 1743 patients interviewed, 1540 completed spirometry, 309 had COPD (FEV1/FVC<0.70) and 102 had a prior diagnosis of COPD. Among spirometry-defined COPD patients, 36.6% used respiratory medications: bronchodilators (BD) 24.9%, CS 13.3%, BD+CS 15.2%. In those with a previous diagnosis, 79.4% used respiratory medications: BD 64.7%, CS 37.6%, BD+CS 25.6%. A total of 81/102 (79%) patients with prior diagnosis were using CS despite not having airway obstruction or exacerbation. In spirometry-defined COPD, dyspnoea (OR 2.09, 95%CI 1.13-3.87), severe airway obstruction (OR 3.36, 95%CI 1.40-8.03) and exacerbation in the past year (OR 5.52, 95%CI 2.19-13.89) were associated with increased respiratory medication use. Among those with a previous diagnosis, use of respiratory medications was associated with cough (OR 5.31, 95%CI 1.28-22.12), severe airway obstruction (OR 29.50, 95%CI 3.18-273.30) and fewer years of schooling (OR 0.12, 95%CI 0.03-0.52).CONCLUSIONS: In the primary care setting, undertreatment is frequent in spirometry-defined COPD patients, and there is increased use of CS (overtreatment) in patients with a previous diagnosis of COPD.