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Observational Study
. 2014 May-Jun;40(3):229-37.
doi: 10.1590/s1806-37132014000300005.

Hospitalized patients with COPD: analysis of prior treatment

[Article in English, Portuguese]
Irai Luis Giacomelli  1 , Leila John Marques Steidle  1 , Frederico Fernandes Moreira  1 , Igor Varela Meyer  1 , Ricardo Goetten Souza  1 , Mariângela Pimentel Pincelli  2
Affiliations
Observational Study

Hospitalized patients with COPD: analysis of prior treatment

[Article in English, Portuguese]
Irai Luis Giacomelli et al. J Bras Pneumol. 2014 May-Jun.

Abstract
in English, Portuguese

Objective: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment.

Methods: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook).

Results: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment.

Conclusions: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.

Objetivo:: Embora a DPOC seja uma enfermidade prevalente, ela é subtratada, e dados sobre o tratamento prévio são desconhecidos em nosso meio. Buscou-se verificar a adequação às recentes diretrizes no que se refere ao tratamento de manutenção em pacientes com DPOC antes de sua hospitalização e identificar possíveis variáveis associadas à inadequação do tratamento.

Métodos:: Estudo transversal, observacional e analítico, que incluiu 50 portadores de DPOC, internados em dois hospitais na cidade de Florianópolis (SC). Aplicou-se um questionário sobre parâmetros relacionados ao tratamento de manutenção da DPOC. Avaliou-se o manejo não farmacológico e a adequação do tratamento farmacológico à terapia preconizada pelo Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 e pelo Caderno de Atenção Básica (CAB) do Ministério da Saúde do Brasil sobre doenças respiratórias crônicas.

Resultados:: Na maioria dos pacientes, a DPOC foi classificada como grave ou muito grave. Em relação ao manejo não farmacológico, 33% eram tabagistas, apenas 32% foram orientados a receber vacinação anti-influenza, 28% receberam vacina anti-pneumocócica, e somente 6,5% dos pacientes nas categorias GOLD B, C e D realizaram reabilitação respiratória. O tratamento farmacológico foi inadequado em 50% e 74% da amostra, respectivamente, em relação às recomendações do GOLD e do CAB. Baseado nas recomendações do GOLD, 38% eram subtratados. Baixa escolaridade, baixa renda, não utilização de oxigenoterapia e ausência de vacinação anti-influenza associaram-se a inadequação do tratamento.

Conclusões:: Não foram seguidas satisfatoriamente várias recomendações do manejo não farmacológico. Segundo o GOLD, a elevada inadequação do tratamento de manutenção foi principalmente devida ao subtratamento. No Brasil, mesmo nos casos mais graves, a otimização do tratamento da DPOC para se obter benefícios mais evidentes continua a ser um desafio.

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References

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