Primary care of the patient with chronic obstructive pulmonary disease in Italy.
Using a general practice research database with general practitioner (GP) clinical records, it has been observed that among the 617,280 subjects registered with 400 Italian GPs, 15,229 (2.47%) patients were suffering from chronic obstructive pulmonary disease (COPD). Of these, 67.7% had a chest radiograph at least once in a period of 10 years (1997-2006), while in the same period only 31.9% had a spirometry, 29.9% had a visit to a specialist, and 0.94% had a visit to an allergologist. From 1997 to 2006, 7.5% of patients with COPD, especially the oldest ones, were hospitalized at least once for the disease, although 44.0% of all patients with COPD were hospitalized for other pathologies. With regard to treatment, in 2006, 10,936 (71.1%) of COPD patients received at least one drug for their disease (drugs classified within the R03 therapeutic pharmacological subgroup of the Anatomical Therapeutic Chemical Classification). In particular, salmeterol/fluticasone was prescribed 6441 times, tiotropium 4962, theophylline 3142, beclomethasone 2853, salbutamol 2256, formoterol 2191, salbutamol/beclomethasone 2129, oxitropium 1802 and formoterol/budesonide 1741 times. Based on these findings, the level of COPD management in Italy seems to fall short of recommended international COPD guidelines. In particular, it appears that GPs usually prescribe treatment without the use of spirometry, and/or without taking into account the severity of airway obstruction. It must also be noted that, in general, patients with COPD are undertreated.
Cazzola
Mario
M
Department of Internal Medicine, Unit of Respiratory Diseases, University of Rome Tor Vergata, Rome, Italy. mario.cazzola@uniroma2.it
Bettoncelli
Germano
G
Sessa
Emiliano
E
Cricelli
Claudio
C
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D011859:Radiography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry / Q000706:statistics & numerical data; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists