Bronchodilator treatment for COPD in primary care of four Latin America countries: The multinational, cross-sectional, non-interventional PUMA study.
Bronchodilators (BDs) are the cornerstone of COPD treatment. However, their underuse has been reported in real-life studies. PUMA is a primary-care study from Argentina, Colombia, Venezuela and Uruguay that could help understand the BD use in terms of frequency for long-acting (LA-BD) and short-acting (SA-BD) BDs alone or associated with corticosteroids (CS), and the use as-needed or on regular basis.



This is a multicentre, multinational, cross-sectional, non-interventional study including no randomised primary-care centres from each country (total 57 centres) without connection with respiratory specialists. Subjects attending routine visits, at-risk for COPD (≥40 years, current or former smokers or exposed to biomass) completed a questionnaire and performed spirometry. COPD was defined as post-BD FEV1/FVC<0.70 and by the lower limit of normal (LLN). Prior physician diagnosis of emphysema, chronic bronchitis or COPD was also determined.



1743 patients were interviewed, 1540 completed spirometry, 309 had COPD by post-BD FEV1/FVC<0.70, 226 by LLN, and 102 had prior medical diagnosis. A total of 77/309 COPD patients by spirometry (24.9%) used BD (3.6% LA-BDs), 15.2% used BD + CS (13.6% LA-BD + CS). Among these patients, SA-BDs (monotherapy) were the most commonly used medication both as-needed (4.5%) and on a regular basis (17.5%). Similar findings were observed using the LLN criteria. In those with prior medical diagnosis, 66/102 (64.7%) used BDs (9.8% LA-BD), and 25.6% used BD + CS (13.6% LA-BD + CS); among them SA-BDs were the most commonly medication used as-needed (9%) and on a regular basis (48.1%). Having health insurance with medication coverage increased the use of BDs.



Up to 60% of COPD patients by spirometry and 10% of those with prior medical diagnosis attending a primary care sample of four Latin American countries did not use BDs. LA-BDs are widely underused on a regular-basis (2.6% and 8.3% of patients with spirometric and medical-diagnosis, respectively) This represents a considerable gap between guideline recommendations and BD prescribing pattern in these centres.
Hospital Universitario de Caracas, Facultad de Medicina, Los Chaguaramos, 1030, Universidad Central de Venezuela, Caracas, Venezuela. Electronic address: montesdeoca.maria@gmail.com.
María
M
Montes de Oca
Facultad de Medicina, Universidad de la República, Hospital Maciel, Montevideo, Uruguay. Electronic address: victorina.lopezvarela@gmail.com.
María Victorina
MV
Lopez Varela
Escola Paulista de Medicina at Federal University of São Paulo, São Paulo, Brazil. Electronic address: jardimpneumo@gmail.com.
Jose
J
Jardim
Faculty of Medical Science of Santa Casa de São Paulo, São Paulo, Brazil. Electronic address: stirbulov@uol.com.br.
Roberto
R
Stirvulov
Medical Affairs, AstraZeneca Latin America, USA. Electronic address: filip.surmont@astrazeneca.com.
Filip
F
Surmont
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D013147:Spirometry; D011795:Surveys and Questionnaires; D014797:Vital Capacity
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations
Bronchodilator; COPD; PUMA; Primary care; Treatment