REG in COPDMarc Miravitlles

Pneumology Department.

Hospital Universitari Vall d’Hebron.Barcelona, Spain. (marcm@separ.es)

Miravitlles et al. Respir Med 2006; 100: 1973-1980

Diagnosis of respiratory symptoms

in general populationRespondents

6,758

No respiratory symptoms4,314 (64%)

Respiratory symptoms2,444 (36%)

Did not consult physician1,073 (44%)

Consult physician1,371 (56%)

No spirometry786 (57.4%)

Spirometry585 (42.6%)

Knowledge of COPD

Miravitlles et al. Respir Med 2006; 100: 1973-1980

%

Survey in 6,758 subjects >40 years.Up to 24% reported having at least one chronic respiratory symptom

Spirometry in Primary

Care

Miravitlles et al. Arch Bronconeumol 2000; 36:

500-5

COPD-6 (FEV1/FEV6)

Represas et al. Arch Bronconeumol 2010; 46: 426-432

Questionnaires and COPD

Martinez et al. COPD 2008; 5: 85-

95

Questionnaires and COPD

Miravitlles et al. Med Clin 2012; 139: 522-530

Cut-off: 4 unitsSensibility: 93.6%Specificity: 64.8%PPV: 69.5%NPV: 92.2%Classified: 78.1%

Marsh et al. Thorax 2008; 63: 761-767

Venn diagram of COPD

The large rectangle represents the full study group. The clear circles represent the proportion of subjects with COPD (FEV1/FVC < 70%).

Adults older than 50 years in New Zealand (n= 469)

Combined assessment of COPD

J Vestbo

Risk

(GO

LD C

lass

ifica

tion

of A

irflow

Lim

itatio

n)

Risk

(Exa

cerb

ation

hist

ory)

2or more

1

0

Symptoms(mMRC or CAT score)

(C) (D)

(A) (B)

mMRC 0-1CAT < 10

4

3

2

1

mMRC 2+CAT 10+

Respiratory Forum 2011

Han et al. Lancet Infect Dis 2012; online

Clasificación GOLD

Han et al. Lancet Infect Dis 2012; online

Clasificación GOLD

Lange et al. AJRCCM 2012; 186: 975-981

Soriano et al. Chest 2012; online first

Clasificación GOLD

Soriano et al. Chest 2012; online first

Mortalidad a los 10 años de seguimiento en pacientes GOLD D

Clasificación GOLD

Soriano et al. Chest 2012; online first

Step 2Step 2Step 2Step 2

Phenotype Phenotype characterisationcharacterisation

Phenotype diagnosisPhenotype diagnosis

Exacerbator phenotypeExacerbator phenotype(2 or more ex/yr)(2 or more ex/yr)

No exacerbationsNo exacerbations< 2 ex/yr< 2 ex/yr

Emphysema Emphysema phenotypephenotype

Chronic bronchitisChronic bronchitisphenotypephenotype

Overlap COPD-asthmaOverlap COPD-asthmaphenotypephenotype

(C)(C) (D)(D)

(B)(B)

(A)(A)

Miravitlles et al. Arch Bronconeumol 2012; 48: 247-257

Phenotypes of COPD

AJRCCM 2010; 182: 598-604

Br J Gen Pract 2012: DOI:10.3399

Phenotypes of COPD

Unpublished

Phenotypes of COPD

Unpublished

CEx. with

emphysema

BOverlap

Bronchodilators

Roflumilast

Antibiotics

ANo exacerbator

DEx. with CB

ICS

Muc/NAC

Phenotype-guided treatment

Miravitlles et al. ERJ 2012; online

Miravitlles et al. Chest 2003; 123: 784-791

€/year

Costs of COPD

Drugs

42

16

42

Visits and diagnostic tests

Hospital costs

Miravitlles et al. Chest 2003; 123: 784-791

Costs of COPD

Miravitlles et al. Respir Med 2009;103:714-721

Costs of treatment of COPD

Thorax 2013;68:4-6

BMJ 2012;345: e7390

SIDIAP

Bolivar et al. Med Clin 2012; 138: 617-621

SIDIAP

Bolivar et al. Med Clin 2012; 138: 617-621

REG in COPD

• Diagnosis of COPD in Primary Care.

• Validation of guidelines

• Compliance with guidelines.

• Cost of illness, cost-effectiveness

• Validation of phenotypes

• Safety of treatments.