title: Geographic differences in clinical characteristics and management of COPD: the EPOCA study.
abstract: OBJECTIVE
  Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines.
  
  
  METHODS
  This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study.
  
  
  RESULTS
  A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV1 = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV1 (%) (r = -0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries.
  
  
  CONCLUSIONS
  Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings.
authors.affiliation: Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, Spain. marcm@clinic.ub.es
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.forename: Cristina
authors.initials: C
authors.lastname: Murio
authors.forename: Gema
authors.initials: G
authors.lastname: Tirado-Conde
authors.forename: Gur
authors.initials: G
authors.lastname: Levy
authors.forename: Hana
authors.initials: H
authors.lastname: Muellerova
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.forename: Alejandra
authors.initials: A
authors.lastname: Ramirez-Venegas
authors.forename: Fanny W S
authors.initials: FW
authors.lastname: Ko
authors.forename: Byron
authors.initials: B
authors.lastname: Canelos-Estrella
authors.forename: Eduardo
authors.initials: E
authors.lastname: Giugno
authors.forename: Miguel
authors.initials: M
authors.lastname: Bergna
authors.forename: Ivan
authors.initials: I
authors.lastname: Chérrez
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D005541:Forced Expiratory Volume; D019983:Guideline Adherence; D019538:Health Care Surveys; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007391:International Cooperation; D020407:Internet; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000627:therapeutic use; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D019141:Respiratory System Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012923:Social Class; D011795:Surveys and Questionnaires; D013806:Theophylline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D055553:Prescription Drugs; D019141:Respiratory System Agents; D013806:Theophylline