Abstract

SIVORI, Martín L.  and  RAIMONDI, Guillermo A.. Survey of chest  physicians regarding copd diagnosis and  treatment. Medicina (B. Aires) [online]. 2004, vol.64, n.2, pp.113-119. ISSN 0025-7680.

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 b₂-agonists (SABA) (65.5%), AC alone (18.8%), long acting b₂-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 influenza and 91.4% pneumococcal vaccination. Thirty seven percent of the patients continued to smoke. Most of reponses regarding diagnosis and exacerbation treatment were in agreement with recommendations of international guidelines. For maintenance treatment the association of AC + SABA was commonly  recommended as first option, whereas IC and LABA were rarely prescribed.

Keywords : COPD; Postal survey; Treatment; Diagnosis.

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