title: COPD screening in primary care in four Latin American countries: methodology of the PUMA Study.
abstract: BACKGROUND
  The prevalence of COPD among patients treated in the healthcare system in Latin America is unknown. The PUMA study (Prevalencia y práctica habitUal -diagnóstico y tratamiento- en población de riesgo de EPOC en Médicos generalistas de 4 países de América Latina) screened at-risk patients attending primary care centers to evaluate the prevalence, diagnosis and treatment of COPD in this setting. The aim of this report is to describe the study methodology.
  
  
  METHODS
  Multicenter, observational, cross-sectional study conducted in Argentina, Colombia, Uruguay and Venezuela. Subjects were≥40 years, smokers, former smokers and/or exposed to fossil fuels attending primary care centers. Eligible patients underwent pre- and post- bronchodilator spirometry and completed standardized questionnaires on demographics, smoking, exposure to environmental/domestic pollution, symptoms/history and management of respiratory diseases, comorbidities, and use of healthcare resources.
  
  
  RESULTS
  A total of 57 centers in 4 countries participated; 1,907 patients were included, 1,743 completed the PUMA questionnaire and 1,540 patients underwent validated spirometry.
  
  
  CONCLUSIONS
  We describe the methodology used in the PUMA study, the first systematic multicenter study in four Latin American countries aimed at detecting COPD cases confirmed by spirometry in primary care. Approximately 90% of patients who completed the PUMA questionnaire underwent valid spirometry tests. This gives room for reflection on the feasibility of opportunistic screening at the primary care level to detect patients in the early stages of COPD or with undiagnosed COPD, and improve the diagnosis and management of this disease.
authors.affiliation: Dirección, Hospital de Rehabilitación Respiratoria «María Ferrer», Buenos Aires, Argentina. Electronic address: eduardo.schiavi@gmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schiavi
authors.affiliation: Departamento de Neumología, Facultad de Ciencias Médicas de Santa Casa de São Paulo, Sao Paulo, Brasil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stirbulov
authors.affiliation: Departamento Médico, AstraZeneca LatAm, Miami, EE. UU.
authors.forename: Ramón
authors.initials: R
authors.lastname: Hernández Vecino
authors.affiliation: Departamento Médico, AstraZeneca S.A., Buenos Aires, Argentina.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mercurio
authors.affiliation: Departamento Médico, AstraZeneca S.A., Buenos Aires, Argentina.
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Boscio
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D003105:Colombia / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D011795:Surveys and Questionnaires; D014583:Uruguay / Q000453:epidemiology; D014687:Venezuela / Q000453:epidemiology
chemical_list: D001993:Bronchodilator Agents; D010100:Oxygen
keywords: Atención primaria; Chronic obstructive pulmonary disease; Detección de casos oportunista; Diagnosis; Diagnóstico; Enfermedad pulmonar obstructiva crónica; Espirometría; Opportunistic screening; Prevalence; Prevalencia; Primary care; Spirometry