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Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey

INTRODUCTION: 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 o...

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Autores principales: Miravitlles, Marc, González-Torralba, Fernando, Represas-Represas, Cristina, Pomares, Xavier, Márquez-Martín, Eduardo, González, Cruz, Amado, Carlos, Forné, Carles, Alonso, Soledad, Alcázar, Bernardino, Barrecheguren, Miriam, Jurado Mirete, Juan María, Naval, Elsa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288191/
https://www.ncbi.nlm.nih.gov/pubmed/35855745
http://dx.doi.org/10.2147/COPD.S369118
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author Miravitlles, Marc
González-Torralba, Fernando
Represas-Represas, Cristina
Pomares, Xavier
Márquez-Martín, Eduardo
González, Cruz
Amado, Carlos
Forné, Carles
Alonso, Soledad
Alcázar, Bernardino
Barrecheguren, Miriam
Jurado Mirete, Juan María
Naval, Elsa
author_facet Miravitlles, Marc
González-Torralba, Fernando
Represas-Represas, Cristina
Pomares, Xavier
Márquez-Martín, Eduardo
González, Cruz
Amado, Carlos
Forné, Carles
Alonso, Soledad
Alcázar, Bernardino
Barrecheguren, Miriam
Jurado Mirete, Juan María
Naval, Elsa
author_sort Miravitlles, Marc
collection PubMed
description INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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spelling pubmed-92881912022-07-17 Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey Miravitlles, Marc González-Torralba, Fernando Represas-Represas, Cristina Pomares, Xavier Márquez-Martín, Eduardo González, Cruz Amado, Carlos Forné, Carles Alonso, Soledad Alcázar, Bernardino Barrecheguren, Miriam Jurado Mirete, Juan María Naval, Elsa Int J Chron Obstruct Pulmon Dis Original Research INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Dove 2022-07-12 /pmc/articles/PMC9288191/ /pubmed/35855745 http://dx.doi.org/10.2147/COPD.S369118 Text en © 2022 Miravitlles et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Miravitlles, Marc
González-Torralba, Fernando
Represas-Represas, Cristina
Pomares, Xavier
Márquez-Martín, Eduardo
González, Cruz
Amado, Carlos
Forné, Carles
Alonso, Soledad
Alcázar, Bernardino
Barrecheguren, Miriam
Jurado Mirete, Juan María
Naval, Elsa
Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
title Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
title_full Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
title_fullStr Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
title_full_unstemmed Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
title_short Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
title_sort pulmonologists’ opinion on the use of inhaled corticosteroids in chronic obstructive pulmonary disease patients in spain: a cross-sectional survey
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288191/
https://www.ncbi.nlm.nih.gov/pubmed/35855745
http://dx.doi.org/10.2147/COPD.S369118
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