Calle Rubio Myriam, Rodríguez Hermosa Juan Luis, Miravitlles Marc, López-Campos José Luis
Pulmonology Department, Research Institute of Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Department of Medicine, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain.
J Clin Med. 2022 May 9;11(9):2670. doi: 10.3390/jcm11092670.
Factors such as seeking medical attention for respiratory symptoms and health professionals ordering spirometry come into play in the underdiagnosis of chronic obstructive pulmonary disease (COPD). The objective of this study was to analyze seeking medical attention and the use of spirometry in individuals with chronic respiratory symptoms and to compare these results with those obtained in the 2005 and 2011 surveys. Material and Methods: A cross-sectional, observational, epidemiological study was conducted via phone interview in December 2020 in Spain, with a representative sample from 17 autonomous communities. The study design was identical to that of the studies carried out in 2005 and 2011 to evaluate the changes that have occurred in seeking medical attention and performing spirometry in Spain, as well as the variability between autonomous communities. Results: From 89,601 phone contacts, a total of 6534 respondents were obtained. A total of 24.8% reported having some chronic respiratory symptom, and 17.9% reported a respiratory disease. Only 51.6% of those who had some chronic respiratory symptom had seen their doctor, which was less likely among current smokers (OR: 0.599, 95% CI: 0.467−0.769, p < 0.001) and those living in a rural setting (OR: 0.797, 95% CI: 0.651−0.975, p = 0.027). A total of 68.7% of the individuals who saw a doctor reported having undergone spirometry, most frequently males (OR: 1.535, 95% CI: 2.074−1.136, p < 0.005), former smokers (OR: 1.696, 95% CI: 2.407−1.195, p < 0.003), and those seen by a pulmonologist (OR: 6.151, 95% CI: 8.869−4.265, p < 0.001). With respect to the 2005 survey, more frequent use of spirometry has been observed (42.6 vs. 68.7%), without any change in seeking medical attention for respiratory symptoms. There is a clear variability according to the autonomous community (p < 0.05). Conclusions: Many individuals with chronic respiratory symptoms do not seek medical attention and although the use of spirometry has increased in the past 15 years, it is still an important area that needs improving in the primary care setting, especially among women. Both of these factors can be determinants in the underdiagnosis of COPD and its variability between autonomous communities.
诸如因呼吸道症状就医以及医疗专业人员安排肺功能测定等因素在慢性阻塞性肺疾病（COPD）的诊断不足中发挥着作用。本研究的目的是分析有慢性呼吸道症状的个体的就医情况及肺功能测定的使用情况，并将这些结果与2005年和2011年调查所得结果进行比较。材料与方法：2020年12月在西班牙通过电话访谈进行了一项横断面、观察性流行病学研究，样本来自17个自治区，具有代表性。该研究设计与2005年和2011年开展的研究相同，以评估西班牙在就医和进行肺功能测定方面发生的变化，以及各自治区之间的差异。结果：在89601次电话联系中，共获得6534名受访者。共有24.8%的人报告有一些慢性呼吸道症状，17.9%的人报告患有呼吸道疾病。在有慢性呼吸道症状的人中，只有51.6%的人看过医生，当前吸烟者（比值比：0.599，95%置信区间：0.467 - 0.769，p < 0.001）和居住在农村地区的人（比值比：0.797，95%置信区间：0.651 - 0.975，p = 0.027）就医的可能性较小。看过医生的人中，共有68.7%的人报告进行过肺功能测定，最常见的是男性（比值比：1.535，95%置信区间：2.074 - 1.136，p < 0.005）、既往吸烟者（比值比：1.696，95%置信区间：2.407 - 1.195，p < 0.003）以及看过肺科医生的人（比值比：6.151，95%置信区间：8.869 - 4.265，p < 0.001）。与2005年的调查相比，已观察到肺功能测定的使用更为频繁（42.6%对68.7%），而因呼吸道症状就医的情况没有变化。各自治区之间存在明显差异（p < 0.05）。结论：许多有慢性呼吸道症状的个体未就医，尽管在过去15年中肺功能测定的使用有所增加，但在初级保健环境中这仍是一个需要改进的重要领域，尤其是在女性中。这两个因素都可能是COPD诊断不足及其在各自治区之间存在差异的决定因素。
