title: Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study.
abstract: BACKGROUND
  COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting.
  
  
  OBJECTIVE
  To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap.
  
  
  METHODS
  COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1or FVC increase ≥200 mL and ≥12%); asthma-COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year.
  
  
  RESULTS
  Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma-COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma-COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients.
  
  
  CONCLUSIONS
  COPD, asthma, and asthma-COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.
authors.affiliation: Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Maria
authors.initials: M
authors.lastname: Montes de Oca
authors.affiliation: Colombian Pneumological Foundation, Bogotá, Colombia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguirre
authors.affiliation: Universidad de la República, Facultad de Medicina, Hospital Maciel, Montevideo, Uruguay.
authors.forename: Maria Victorina
authors.initials: MV
authors.lastname: Lopez Varela
authors.affiliation: Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Laucho-Contreras
authors.affiliation: Colombian Pneumological Foundation, Bogotá, Colombia.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Casas
authors.affiliation: Medical Affairs, AstraZeneca Latin America, Coral Gables, FL, USA.
authors.forename: Filip
authors.initials: F
authors.lastname: Surmont
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D058006:General Practice; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010641:Phenotype; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013020:South America; D013147:Spirometry / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: COPD; PUMA; asthma; asthma-COPD overlap; exacerbation; health care resource utilization; primary care