REG in COPDMarc Miravitlles
Pneumology Department.
Hospital Universitari Vall d’Hebron.Barcelona, Spain. ([email protected])
Miravitlles et al. Respir Med 2006; 100: 1973-1980
Diagnosis of respiratory symptoms
in general populationRespondents
6,758
No respiratory symptoms4,314 (64%)
Respiratory symptoms2,444 (36%)
Did not consult physician1,073 (44%)
Consult physician1,371 (56%)
No spirometry786 (57.4%)
Spirometry585 (42.6%)
Knowledge of COPD
Miravitlles et al. Respir Med 2006; 100: 1973-1980
%
Survey in 6,758 subjects >40 years.Up to 24% reported having at least one chronic respiratory symptom
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
Miravitlles et al. Med Clin 2012; 139: 522-530
Cut-off: 4 unitsSensibility: 93.6%Specificity: 64.8%PPV: 69.5%NPV: 92.2%Classified: 78.1%
Marsh et al. Thorax 2008; 63: 761-767
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)
Combined assessment of COPD
J Vestbo
Risk
(GO
LD C
lass
ifica
tion
of A
irflow
Lim
itatio
n)
Risk
(Exa
cerb
ation
hist
ory)
2or more
1
0
Symptoms(mMRC or CAT score)
(C) (D)
(A) (B)
mMRC 0-1CAT < 10
4
3
2
1
mMRC 2+CAT 10+
Respiratory Forum 2011
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
Soriano et al. Chest 2012; online first
Mortalidad a los 10 años de seguimiento en pacientes GOLD D
Clasificación GOLD
Soriano et al. Chest 2012; online first
Step 2Step 2Step 2Step 2
Phenotype Phenotype characterisationcharacterisation
Phenotype diagnosisPhenotype diagnosis
Exacerbator phenotypeExacerbator phenotype(2 or more ex/yr)(2 or more ex/yr)
No exacerbationsNo exacerbations< 2 ex/yr< 2 ex/yr
Emphysema Emphysema phenotypephenotype
Chronic bronchitisChronic bronchitisphenotypephenotype
Overlap COPD-asthmaOverlap COPD-asthmaphenotypephenotype
(C)(C) (D)(D)
(B)(B)
(A)(A)
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Unpublished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Unpublished
CEx. with
emphysema
BOverlap
Bronchodilators
Roflumilast
Antibiotics
ANo exacerbator
DEx. with CB
ICS
Muc/NAC
Phenotype-guided treatment
Miravitlles et al. ERJ 2012; online
Miravitlles et al. Chest 2003; 123: 784-791
€/year
Costs of COPD
Drugs
42
16
42
Visits and diagnostic tests
Hospital costs
Miravitlles et al. Chest 2003; 123: 784-791
Costs of COPD
Miravitlles et al. Respir Med 2009;103:714-721
Costs of treatment of COPD
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.