REG in COPD
Marc Miravitlles
Pneumology Department.
Hospital Universitari Vall d’Hebron.
Barcelona, Spain. (marcm@separ.es)
Diagnosis of respiratory symptoms
in general population
Respondents
6,758
No respiratory symptoms
4,314 (64%)
Respiratory symptoms
2,444 (36%)
Did not consult physician
1,073 (44%)
Consult physician
1,371 (56%)
No spirometry
786 (57.4%)
Spirometry
585 (42.6%)
Miravitlles et al. Respir Med 2006; 100: 1973-1980
Knowledge of COPD
%
Survey in 6,758
subjects >40 years.
Up to 24% reported
having at least one
chronic respiratory
symptom
20
15
10
5
0
Non smokers Smokers High risk
Miravitlles et al. Respir Med 2006; 100: 1973-1980
Spirometry in
Primary Care
Miravitlles et al. Arch
Bronconeumol 2000; 36: 500-5
COPD-6 (FEV1/FEV6)
Represas et al. Arch Bronconeumol 2010; 46: 426-432
Questionnaires
and COPD
Martinez et al. COPD
2008; 5: 85-95
Questionnaires and COPD
Cut-off: 4 units
Sensibility: 93.6%
Specificity: 64.8%
PPV: 69.5%
NPV: 92.2%
Classified: 78.1%
Miravitlles et al. Med Clin 2012; 139: 522-530
Venn diagram of COPD
The large rectangle represents
the full study group. The clear
circles represent the proportion
of subjects with COPD
(FEV1/FVC < 70%).
Adults older than 50 years in
New Zealand (n= 469)
Marsh et al. Thorax 2008; 63: 761-767
(C)
(D)
2
or
more
(B)
1
3
2
(A)
1
0
mMRC 0-1
CAT < 10
Respiratory Forum 2011
(Exacerbation history)
4
Risk
(GOLD Classification of Airflow Limitation)
Risk
Combined assessment of COPD
mMRC 2+
CAT 10+
Symptoms
(mMRC or CAT score)
J Vestbo
Han et al. Lancet Infect Dis 2012; online
Clasificación GOLD
Han et al. Lancet Infect Dis 2012; online
Clasificación GOLD
Lange et al. AJRCCM 2012; 186: 975-981
Soriano et al. Chest 2012; online first
Clasificación GOLD
Mortalidad a los 10 años
de seguimiento en
pacientes GOLD D
Soriano et al. Chest 2012; online first
Clasificación GOLD
Soriano et al. Chest 2012; online first
Phenotype diagnosis
Step 2
Phenotype characterisation
Overlap COPD-asthma
phenotype
Exacerbator phenotype
(2 or more ex/yr)
(C)
(D)
(B)
(A)
No exacerbations
< 2 ex/yr
Emphysema
phenotype
Chronic bronchitis
phenotype
Miravitlles et al. Arch Bronconeumol 2012; 48: 247-257
Phenotypes of COPD
AJRCCM 2010; 182: 598-604
Br J Gen Pract 2012: DOI:10.3399
Phenotypes of COPD
Unpublished
Phenotypes of COPD
Unpublished
Phenotype-guided treatment
A
No exacerbator
B
Overlap
C
Ex. with
emphysema
D
Ex. with CB
Bronchodilators
ICS
Muc/NAC
Roflumilast
Antibiotics
Miravitlles et al. ERJ 2012; online
Costs of COPD
€/year
3000
2500
2000
1500
1000
500
0
Leve
Moderada
Grave
Miravitlles et al. Chest 2003; 123: 784-791
Costs of COPD
Visits and
diagnostic
tests
16
42
42
Hospital costs
Drugs
Miravitlles et al. Chest 2003; 123: 784-791
Costs of treatment of COPD
Miravitlles et al. Respir Med 2009;103:714-721
Thorax 2013;68:4-6
BMJ 2012;345: e7390
SIDIAP
Bolivar et al. Med Clin 2012; 138: 617-621
SIDIAP
Bolivar et al. Med Clin 2012; 138: 617-621
REG in COPD
• Diagnosis of COPD in Primary Care.
• Validation of guidelines
• Compliance with guidelines.
• Cost of illness, cost-effectiveness
• Validation of phenotypes
• Safety of treatments.