RT Journal Article
T1 Pulmonologists' Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey.
A1 Miravitlles, Marc
A1 González-Torralba, Fernando
A1 Represas-Represas, Cristina
A1 Pomares, Xavier
A1 Márquez-Martín, Eduardo
A1 González, Cruz
A1 Amado, Carlos
A1 Forné, Carles
A1 Alonso, Soledad
A1 Alcázar, Bernardino
A1 Barrecheguren, Miriam
A1 Jurado Mirete, Juan María
A1 Naval, Elsa
K1 COPD
K1 bronchodilators
K1 eosinophils
K1 exacerbation
K1 inhaled corticosteroids
K1 withdrawal
AB Identifying the variables that guide decision-making in relation to the use of inhaled corticosteroids (ICS) can contribute to the appropriate use of these drugs. The objective of this study was to identify the clinical variables that physicians consider most relevant for prescribing or withdrawing ICS in COPD. A cross-sectional survey was conducted in Spain from November 2020 to May 2021. Therapeutic decisions on the use of ICS in 11 hypothetical COPD patient profiles were collected using an online survey answered by specialists with experience in the management of patients with COPD. Mixed-effects logistic regression was used to analyze the impact of patients' characteristics in the therapeutic decision for prescribing ICS or proceeding to its withdrawal. A total of 74 pulmonologists agreed to collaborate in the survey and answered the questionnaire. The results showed great variability, with only 2 profiles achieving consensus for starting or withdrawing the treatment. The frequency and severity of exacerbations influenced the decision to prescribe ICS in a dose-response fashion (1 exacerbation odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.02 to 3.43, two exacerbations OR = 11.6, 95% CI: 4.47 to 30.2 and three OR = 123, 95% CI: 25 to 601). Similarly, increasing blood eosinophils and history of asthma were associated with ICS use. On the other hand, pneumonia reduced the probability of initiating treatment with ICS (OR = 0.54 [0.29 to 0.98]). Lung function and dyspnea degree did not influence the clinician's therapeutic decision. The results for withdrawal of ICS were similar but in the opposite direction. In accordance with guidelines, exacerbations, blood eosinophils and history of asthma or pneumonia are the factors considered by pulmonologist for the indication or withdrawal of ICS. However, the agreement in prescription or withdrawal of ICS when confronted with hypothetical cases is very low, suggesting a great variability in clinical practice.
YR 2022
FD 2022-07-12
LK http://hdl.handle.net/10668/20458
UL http://hdl.handle.net/10668/20458
LA en
DS RISalud
RD Apr 5, 2025