Has the treatment of COPD changed in Spain? Results of a community multicenter study (VICE)

Many Clinical Practical Guides (CPG) that have specifically focused on the diagnosis and treatment of chronic obstructive pulmonary disease (COPD) have been elaborated over the last 5 years. However, their grade of application and effectiveness have not been verified. In order to evaluate if the diagnosis and treatment of COPD have been modified in our setting since their publication, a comparative analysis was proposed between the results of the IDENTEPOC study (n = 898) conducted in the year 2000 and the VICE study (n = 10,782), whose data were collected in 2005. In the year 2000, 38.6% of the patients in primary health care were initially diagnosed of COPD using clinical and/or radiological criteria, with no functional confirmation versus 10.2% in the pneumology setting (p < 0.001). In 2005, 31% of the subjects had been diagnosed of COPD using spirometry in primary health care and 14% in pneumology did not show an obstructive pattern. In 2005, only 4.1% of the patients were receiving specific treatment for their smoking habit and the establishment of rehabilitation programs was not very relevant. No large differences in drug treatments were observed between both studies. The main difference in 2005 was a wide use of tiotropium and of combinations of beta2 agonists with inhaled corticosteroids. Although a mild escalation of treatment based on seriousness is observed in both series, the prescription guidelines do not adjust to the criteria established by the regulations. The results of this analysis indicate that although the CPGs may be useful tools to improve the clinical management of COPD, the absence of relevant qualitative changes in the management of COPD after their publication suggests that their impact in the clinical practice is currently irrelevant.