title: Respiratory medication use in primary care among COPD subjects in four Latin American countries.
abstract: To assess respiratory medications used, factors predicting treatment and patterns of corticosteroid (CS) use in primary care in Latin America among chronic obstructive pulmonary disease (COPD) patients.
  
  
  
  COPD was defined as post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) < 0.70 or previous medical diagnosis. To determine factors associated with respiratory medication use, crude and adjusted Poisson regression models were performed.
  
  
  
  Of 1743 patients interviewed, 1540 completed spirometry, 309 had COPD (FEV1/FVC<0.70) and 102 had a prior diagnosis of COPD. Among spirometry-defined COPD patients, 36.6% used respiratory medications: bronchodilators (BD) 24.9%, CS 13.3%, BD+CS 15.2%. In those with a previous diagnosis, 79.4% used respiratory medications: BD 64.7%, CS 37.6%, BD+CS 25.6%. A total of 81/102 (79%) patients with prior diagnosis were using CS despite not having airway obstruction or exacerbation. In spirometry-defined COPD, dyspnoea (OR 2.09, 95%CI 1.13-3.87), severe airway obstruction (OR 3.36, 95%CI 1.40-8.03) and exacerbation in the past year (OR 5.52, 95%CI 2.19-13.89) were associated with increased respiratory medication use. Among those with a previous diagnosis, use of respiratory medications was associated with cough (OR 5.31, 95%CI 1.28-22.12), severe airway obstruction (OR 29.50, 95%CI 3.18-273.30) and fewer years of schooling (OR 0.12, 95%CI 0.03-0.52).
  
  
  
  In the primary care setting, undertreatment is frequent in spirometry-defined COPD patients, and there is increased use of CS (overtreatment) in patients with a previous diagnosis of COPD.
authors.affiliation: Federal University of São Paulo, São Paulo.
authors.forename: J R
authors.initials: JR
authors.lastname: Jardim
authors.affiliation: Faculty of Medical Science of Santa Casa de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Stirbulov
authors.affiliation: Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: D
authors.initials: D
authors.lastname: Moreno
authors.affiliation: Facultad de Ciencias Médicas Universidad del Comahue, Rio Negro, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Zabert
authors.affiliation: Universidad de la República, Hospital Maciel Montevideo, Montevideo, Uruguay.
authors.forename: M V
authors.initials: MV
authors.lastname: Lopez-Varela
authors.affiliation: Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: M
authors.initials: M
authors.lastname: Montes de Oca
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D013147:Spirometry; D014797:Vital Capacity
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents