Departamento de Medicina y Especialidades, Universidad de Alcalá, Madrid, España; Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España.
Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España.
Arch Bronconeumol (Engl Ed). 2021 Feb;57(2):94-100. doi: 10.1016/j.arbres.2019.12.025. Epub 2020 Feb 22.
The aim of this study was to evaluate the quality of diagnosis and treatment of COPD using Big Data methodology on the Savana Manager 2.1 clinical platform.
A total of 59,369 patients with a diagnosis of COPD were included from a population of 1,219,749 adults over 40 years of age.
In total, 78% were men. Spirometry data were available for only 26,453 (43.5%) subjects. Disease severity was classified in 18,172 patients: 4,396 mild, 7,100 moderate, and 6,676 severe, although only 27%, 34%, and 28%, respectively, presented obstructive spirometry. The clinical management of COPD is mainly the responsibility of the primary care and pulmonology departments, while internal medicine and, to a lesser extent, geriatrics also participate. Drug treatment was based on bronchodilators and inhaled corticosteroids (ICS). A marked decline in the use of long-acting beta-2 agonists (LABA) in monotherapy and a slight reduction in ICS/LABA combinations, associated with a LAMA in 74% of cases, was observed. All-cause in-hospital mortality among the overall population was 5.6% compared to 1% of the general population older than 40 years. In total, 35% were admitted to hospital, with an average stay of 6.6 days and a rate of hospital mortality in this group of 10.74%.
This study identifies the main features of an unselected COPD population and the major errors made in the management of the disease.
本研究旨在利用 Savana Manager 2.1 临床平台上的大数据方法评估 COPD 的诊断和治疗质量。
共纳入 1219749 名 40 岁以上成年人中诊断为 COPD 的 59369 例患者。
共有 78%为男性。仅对 26453 名（43.5%）患者进行了肺量计数据检测。根据 18172 例患者的疾病严重程度进行了分类：4396 例为轻度，7100 例为中度，6676 例为重度，尽管只有 27%、34%和 28%分别表现出阻塞性肺功能障碍。COPD 的临床管理主要由初级保健和肺病科负责，同时内科也有参与，老年医学科参与程度较小。药物治疗主要基于支气管扩张剂和吸入性皮质类固醇（ICS）。长效β2 受体激动剂（LABA）单药治疗的使用率显著下降，ICS/LABA 联合治疗略有减少，同时 LAMA 在 74%的病例中联合使用。与一般 40 岁以上人群的 1%相比，总体人群的全因院内死亡率为 5.6%。共有 35%的患者住院，平均住院时间为 6.6 天，该组的住院死亡率为 10.74%。
本研究确定了未选择的 COPD 人群的主要特征和疾病管理中的主要错误。
