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: Miravitlles Fernández, Marc, González-Torralba, Fernando, Represas-Represas, Cristina, Pomares, Xavier, Márquez-Martín, Eduardo, González, Cruz, Amado, Carlos Antonio, Forné Izquierdo, Carles, Alonso, Soledad, Alcázar-Navarrete, Bernardino, Barrecheguren, Miriam, Jurado Mirete, Juan María, Naval, Elsa
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universitat de Lleida (UdL)
Repositorio:Repositori Obert UdL
OAI Identifier:oai:repositori.udl.cat:10459.1/84890
Acceso en línea:https://doi.org/10.2147/COPD.S369118
http://hdl.handle.net/10459.1/84890
Access Level:acceso abierto
Palabra clave:COPD
Exacerbation
Bronchodilators
Inhaled corticosteroids
Eosinophils
Withdrawal
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spelling Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional SurveyMiravitlles Fernández, MarcGonzález-Torralba, FernandoRepresas-Represas, CristinaPomares, XavierMárquez-Martín, EduardoGonzález, CruzAmado, Carlos AntonioForné Izquierdo, CarlesAlonso, SoledadAlcázar-Navarrete, BernardinoBarrecheguren, MiriamJurado Mirete, Juan MaríaNaval, ElsaCOPDExacerbationBronchodilatorsInhaled corticosteroidsEosinophilsWithdrawalIntroduction: 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 PressTaylor and Francis Group2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://doi.org/10.2147/COPD.S369118http://hdl.handle.net/10459.1/84890reponame:Repositori Obert UdL instname:Universitat de Lleida (UdL)InglésReproducció del document publicat a https://doi.org/10.2147/COPD.S369118International Journal of Chronic Obstructive Pulmonary Disease, 2022, vol. 27, p. 1577–1587cc-by-nc (c) Marc Miravitlles et. al., 2022info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc/4.0/oai:repositori.udl.cat:10459.1/848902026-06-24T12:42:17Z
dc.title.none.fl_str_mv 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
spellingShingle Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
Miravitlles Fernández, Marc
COPD
Exacerbation
Bronchodilators
Inhaled corticosteroids
Eosinophils
Withdrawal
title_short 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_sort Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
dc.creator.none.fl_str_mv Miravitlles Fernández, Marc
González-Torralba, Fernando
Represas-Represas, Cristina
Pomares, Xavier
Márquez-Martín, Eduardo
González, Cruz
Amado, Carlos Antonio
Forné Izquierdo, Carles
Alonso, Soledad
Alcázar-Navarrete, Bernardino
Barrecheguren, Miriam
Jurado Mirete, Juan María
Naval, Elsa
author Miravitlles Fernández, Marc
author_facet Miravitlles Fernández, Marc
González-Torralba, Fernando
Represas-Represas, Cristina
Pomares, Xavier
Márquez-Martín, Eduardo
González, Cruz
Amado, Carlos Antonio
Forné Izquierdo, Carles
Alonso, Soledad
Alcázar-Navarrete, Bernardino
Barrecheguren, Miriam
Jurado Mirete, Juan María
Naval, Elsa
author_role author
author2 González-Torralba, Fernando
Represas-Represas, Cristina
Pomares, Xavier
Márquez-Martín, Eduardo
González, Cruz
Amado, Carlos Antonio
Forné Izquierdo, Carles
Alonso, Soledad
Alcázar-Navarrete, Bernardino
Barrecheguren, Miriam
Jurado Mirete, Juan María
Naval, Elsa
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COPD
Exacerbation
Bronchodilators
Inhaled corticosteroids
Eosinophils
Withdrawal
topic COPD
Exacerbation
Bronchodilators
Inhaled corticosteroids
Eosinophils
Withdrawal
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.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://doi.org/10.2147/COPD.S369118
http://hdl.handle.net/10459.1/84890
url https://doi.org/10.2147/COPD.S369118
http://hdl.handle.net/10459.1/84890
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a https://doi.org/10.2147/COPD.S369118
International Journal of Chronic Obstructive Pulmonary Disease, 2022, vol. 27, p. 1577–1587
dc.rights.none.fl_str_mv cc-by-nc (c) Marc Miravitlles et. al., 2022
info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by-nc/4.0/
rights_invalid_str_mv cc-by-nc (c) Marc Miravitlles et. al., 2022
http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Dove Press
Taylor and Francis Group
publisher.none.fl_str_mv Dove Press
Taylor and Francis Group
dc.source.none.fl_str_mv reponame:Repositori Obert UdL
instname:Universitat de Lleida (UdL)
instname_str Universitat de Lleida (UdL)
reponame_str Repositori Obert UdL
collection Repositori Obert UdL
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,808905

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