López-Campos, Jose LuisAbad Arranz, MaríaCalero Acuña, CarmenRomero Valero, FernandoAyerbe García, RuthHidalgo Molina, AntonioAguilar Perez-Grovas, Ricardo IGarcía Gil, FranciscoCasas Maldonado, FranciscoCaballero Ballesteros, LauraSánchez Palop, MaríaPérez-Tejero, DoloresSegado, AlejandroCalvo Bonachera, JoseHernández Sierra, BárbaraDoménech, AdolfoArroyo Varela, MacarenaGonzález Vargas, FranciscoCruz Rueda, Juan J2025-01-072025-01-072016-06-02https://hdl.handle.net/10668/24507This study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment. This study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation. The present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99 patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1 second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment. The majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up.enAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/airway diseasesfollow-upoutpatient carequality of carerespiratory diseasestreatment strategiesAdministration, InhalationAdrenal Cortex HormonesAgedAnti-Bacterial AgentsBronchodilator AgentsClinical Decision-MakingDisease ProgressionDrug PrescriptionsDrug Therapy, CombinationFemaleForced Expiratory VolumeGuideline AdherenceHumansLogistic ModelsLungMaleMedical AuditMiddle AgedMultivariate AnalysisOdds RatioOutpatient Clinics, HospitalPhenotypePilot ProjectsPractice Guidelines as TopicPractice Patterns, Physicians'Process Assessment, Health CarePulmonary Disease, Chronic ObstructiveSecondary CareTreatment OutcomeVital Capacityresearch article27330285open access10.2147/COPD.S1036141178-2005PMC4898035https://www.dovepress.com/getfile.php?fileID=30711https://pmc.ncbi.nlm.nih.gov/articles/PMC4898035/pdf