Geographic differences in clinical characteristics and management of COPD: the EPOCA study

Marc Miravitlles¹, Cristina Murio², Gema Tirado-Conde¹, Gur Levy³, Hana Muellerova⁴, Joan B Soriano⁵, Alejandra Ramirez-Venegas⁶, Fanny WS Ko⁷, Byron Canelos-Estrella⁸, Eduardo Giugno⁹, Miguel Bergna⁹, Ivan Chérrez¹⁰, Antonio Anzueto¹¹

¹Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, Spain; ²Secció de Pneumologia, Hospital General de Catalunya, Barcelona, Spain; ³Servicio de Neumonología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela; ⁴GlaxoSmithKline, Greenford, UK and Research Triangle Park, USA; ⁵Programa de Epidemiología e Investigación Clínica, Fundación Caubet-CIMERA Bunyola, Illes Balears, Spain; ⁶Departamento de Investigacion en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México; ⁷Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, New Territories, Peoples Republic of China; ⁸Hospital Metropolitano, Universidad Central del Ecuador y Pontificia Universidad Católica del Ecuador, Quito, Ecuador; ⁹Hospital del Tórax Dr. Antonio Cetrangolo, Vicente López, Buenos Aires, Argentina; ¹⁰RESPIRALAB-Hospital Kennedy, Guayaquil, Ecuador; ¹¹Division of Pulmonary and Critical Care Medicine at the South Texas Veterans Health Care System Audie L Murphy Division and the University of Texas Health Science Center, San Antonio, TX USA

Aims: Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines.

Method: This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study.

Results: A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV₁ = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV₁(%) (r = –0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries.

Conclusions: Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings.

Keywords: COPD, epidemiology, EPOCA, socioeconomics