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      ¿Los estudios de prevalencia de zona básica de salud tienen sentido en medicina familiar y comunitaria? A propósito de un caso: la enfermedad pulmonar obstructiva crónica Translated title: Are health district prevalence studies useful in family practice? Report of a case: Chronic obstructive pulmonary disease

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          Resumen

          Objetivo

          Determinar la prevalencia de EPOC y tabaquismo en nuestra Zona Básica de Salud (ZBS) y su correlación con la prevalencia extrapolada y la morbilidad registrada. Conocer el perfil personal, familiar y social. Determinar la validez del test de función pulmonar.

          Diseño

          Estudio de prevalencia.

          Emplazamiento

          ZBS urbana.

          Participantes

          Docientas treinta y tres personas de 40 a 75 años seleccionadas aleatoriamente.

          Mediciones principales

          Edad, sexo, paquetes/año, espirometría, pulsioximetría, medicación, ingresos. Tests: Fagerström, Richmond, MOS, APGAR y función pulmonar.

          Resultados

          Edad media: 53,7 ± 7,6 años; 57,9% mujeres. EPOC: morbilidad registrada 1,2% (0,5-3,9%). Prevalencia: 4,7% (1,5% mujeres, 9,2% hombres); prevalencia extrapolada: 10,2%. Tabaquismo: morbilidad registrada: 10,7% (1-19,4%); prevalencia: 18,5% (20% mujeres, 16,3% hombres); prevalencia extrapolada: 23,95%. Test de función pulmonar: cociente de probabilidad positivo: 3,18, y negativo: 0,1. Alta probabilidad de EPOC (59,5%) si > 30 paquetes/año. Los fumadores fuman como media 20,8 paquetes/año. Dependencia física más alta en mujeres (36% versus 21,4%). Mayor probabilidad de deshabituación tabáquica en hombres (57,1% versus 44%). El 14,7% percibe disfunción familiar. El 6,9% tienen bajo apoyo social y el 9,1% en EPOC. El 70% de los pacientes EPOC nunca han ingresado. El 10% son polimedicados versus el 60% de los EPOC.

          Conclusiones

          Las prevalencias de EPOC y de tabaquismo (indicador de morbilidad evitable imputable a atención primaria) son sustancialmente inferiores a las prevalencias extrapoladas. El test de función pulmonar es válido. La variablidad interprofesional es elevada. Las mujeres fuman más, tienen más dependencia y menos motivación para el abandono. Su percepción familiar y social es peor. Estas investigaciones son fundamentales para la intervención comunitaria y la planificación operativa.

          Translated abstract

          Objective

          To determine the prevalence of COPD and smoking in a Health District, to correlate real, registered, and extrapolated morbidity. To determine personal, family and social profiles. To determine the validity of the lung function questionnaire.

          Design

          Prevalence study.

          Location

          Urban District Health.

          Participants

          Random selection of 233 people aged 40-75 years.

          Main measurements

          Age, sex, pack/years, spirometry, pulse-oximetry, medication, income. Tests: Fagerström, Richmond, MOS, APGAR, and lung function.

          Results

          Mean age was 53.7 + 7.6 years, with 57.9% women. Registered morbidity for COPD 1.2% (0.5-3.9%). Prevalence 4.7% (1.5% female, 9.2% male), extrapolated prevalence: 10.2%. Registered morbidity for Smoking 10.7% (1-19.4%); prevalence: 18.5% (20% female, 16.3% male), extrapolated prevalence 23.95%. Lung function questionnaire: positive likelihood ratio 3.18; negative 0.1. High probability of COPD (59.5%) in > 30 packs/year smokers. Smokers consume a mean of 20.8 packs/year. Women showed higher physical dependence (36% versus 21%). More probability of achieving successful smoking cessation in men (57.1% versus 44%). There was 14.7% perceived family dysfunction; 6.9% have a low global index of social support, and 9.1% in COPD subjects. More than two-thirds (70%) of COPD patients had never been hospitalized. There were 10% polymedicated patients compared to 60% in identified COPDs.

          Conclusions

          Prevalence of COPD and smoking (indicator of avoidable morbidity attributable to primary care) are substantially lower than the reference data. The lung function questionnaire is valid. There was evidence of inter-professional variability. Women smoke more, are more dependent and are less motivated to quit. Their family and social perception is worse. These investigations are essentials for community intervention and operational planning.

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          Most cited references22

          • Record: found
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          Chronic obstructive pulmonary disease in non-smokers.

          Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25-45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1.01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.
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            Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study.

            To determine whether a program incorporating smoking intervention and use of an inhaled bronchodilator can slow the rate of decline in forced expiratory volume in 1 second (FEV1) in smokers aged 35 to 60 years who have mild obstructive pulmonary disease. Randomized clinical trial. Participants randomized with equal probability to one of the following groups: (1) smoking intervention plus bronchodilator, (2) smoking intervention plus placebo, or (3) no intervention. Ten clinical centers in the United States and Canada. A total of 5887 male and female smokers, aged 35 to 60 years, with spirometric signs of early chronic obstructive pulmonary disease. Smoking intervention: intensive 12-session smoking cessation program combining behavior modification and use of nicotine gum, with continuing 5-year maintenance program to minimize relapse. Bronchodilator: ipratropium bromide prescribed three times daily (two puffs per time) from a metered-dose inhaler. Rate of change and cumulative change in FEV1 over a 5-year period. Participants in the two smoking intervention groups showed significantly smaller declines in FEV1 than did those in the control group. Most of this difference occurred during the first year following entry into the study and was attributable to smoking cessation, with those who achieved sustained smoking cessation experiencing the largest benefit. The small noncumulative benefit associated with use of the active bronchodilator vanished after the bronchodilator was discontinued at the end of the study. An aggressive smoking intervention program significantly reduces the age-related decline in FEV1 in middle-aged smokers with mild airways obstruction. Use of an inhaled anticholinergic bronchodilator results in a relatively small improvement in FEV1 that appears to be reversed after the drug is discontinued. Use of the bronchodilator did not influence the long-term decline of FEV1.
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              Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.

              This study aimed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in Spain and identify the level of undiagnosed disease and its impact on health-related quality of life (HRQL) and activities of daily living (ADL). A population-based sample of 4274 adults aged 40-80 years was surveyed. They were invited to answer a questionnaire and undergo prebrochodilator and postbronchodilator spirometry. COPD was defined as a postbronchodilator FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. For 3802 participants with good-quality postbronchodilator spirometry, the overall prevalence of COPD was 10.2% (95% CI 9.2% to 11.1%) and was higher in men (15.1%) than in women (5.6%). The prevalence of COPD stage II or higher was 4.4% (95%CI; 3.8%-5.1%). The prevalence of COPD increased with age and with cigarette smoking and was higher in those with a low educational level. A previous diagnosis of COPD was reported by only 27% of those with COPD. Diagnosed patients had more severe disease, higher cumulative tobacco consumption and more severely impaired HRQL compared with undiagnosed subjects. However, even patients with undiagnosed COPD stage I+ already showed impairment in HRQL and in some aspects of ADL compared with participants without COPD. The prevalence of COPD in individuals between 40 and 80 years of age in Spain is 10.2% and increases with age, tobacco consumption and lower educational levels. The rate of diagnosised COPD is very high and undiagnosed individuals with COPD already have a significant impairment in HRQL and ADL.
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                Author and article information

                Contributors
                Journal
                Aten Primaria
                Aten Primaria
                Atencion Primaria
                Elsevier
                0212-6567
                1578-1275
                31 March 2015
                November 2015
                31 March 2015
                : 47
                : 9
                : 581-588
                Affiliations
                [0005]Centro de Salud Universitario Parquesol, Valladolid, España
                Author notes
                [* ]Autor para correspondencia. veronica.casado@ 123456telefonica.net
                [◊]

                Los miembros del Grupo de investigación ParquEPOC aparecen en el Anexo 1.

                Article
                S0212-6567(15)00053-0
                10.1016/j.aprim.2014.12.009
                6983788
                25835344
                84439f29-7a94-4299-97e0-5875c3f29da4
                © 2014 Elsevier Espa˜na, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 24 August 2014
                : 18 December 2014
                Categories
                Originales

                enfermedad pulmonar obstructiva crónica,prevalencia real,prevalencia extrapolada,morbilidad registrada,zona básica de salud,salud comunitaria,chronic obstructive pulmonary disease,actual prevalence,prevalence extrapolated,registered morbidity,health district,community health

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