PREVALENCIA DE ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA EN UNA CONSULTA DE RIESGO CARDIOVASCULAR

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in developed countries, yet it is often underdiagnosed. Patients diagnosed with COPD are at least at a moderate risk for developing cardiovascular disease, which is frequently their main cause of death. Cardiovascular risk units have shown their cost-effectiveness preventing cardiovascular events and are widespread. These hospital facilities could serve as a COPD-screening tool for early diagnosis and long-term prognosis improvement._x000D_ Objective: To estimate COPD prevalence on a cardiovascular risk unit, evaluating underdiagnosis and description of related clinical features._x000D_ Methods: Transversal observational study performed at the Cardiovascular Risk Unit at Parc Sanitari Sant Joan de Déu. All patients attending this unit were invited to join the study. Only those with low cardiovascular risk (measured through CardioRisc score) or cognitive impairment were excluded. We estimated a clinical relevant COPD prevalence on 15%. The sample size needed to demonstrate this prevalence with an alpha error of 5% and a 80% power was calculated in 168 individuals._x000D_ Results: 169 individuals were included. Mean age was 68 years-old and 67% are men. Hypertension (98.2%), dyslipemia (79.9%) and diabetes (43.8%) were the most frequent comorbidities. At inclusion, 74% of patients had organic cardiovascular damage. COPD prevalence was 21.3% (IC95% 15.5-28.4), ranging from 24% for those with cardiovascular organic damage to 13.6% in those without. Variables related to COPD were gender (male), heavy tobacco use, presence of renal damage, elevated creatinine plasma levels, lower LDL-Cholesterol plasma levels, more hospital admissions in previous year, higher scores in CECA questionnaire (more symptomatic) and anaemia. Total underdiagnosis was 47%, with gender differences (83.3% women, 40% men). Women were 16.6% of total COPD patients. The most frequent spirometric alteration in our study was mixed pattern (combined obstructive and restrictive) (24.3%)_x000D_ Discussion: This is the first study determining COPD prevalence at a Cardiovascular risk Unit. This result (21.3%) doubles the standard general population prevalence in our setting (10.2%), related to the association between COPD and cardiovascular disease. The more frequent cardiovascular organ damage was nephropathy, and the grade of obstruction in spirometry was directly related to renal impairment. COPD patients had more comorbidities reflected on the Charlson and age corrected Charlson index, which were clearly higher. Women constituted a low proportion of all COPD patients but their underdiagnosis was higher than in men, probably linked to a lower suspicion from physicians. Individuals with not previously known COPD had low level simptomatology, low ratio of hospital admissions in previous year and better spirometric values (mainly GOLD I-II). The lack of relevant clinical findings related to incident COPD hampers the selection of a high-risk group for developing COPD. The generalization of this test will probably lead to earlier diagnosis of COPD and a better understanding of its natural evolution. Finally, we probably could find some COPD among the individuals with mixed pattern spirometry, and their inclusion could modify some characteristics of this subgroup of patients._x000D_ Conclusions: COPD prevalence in our study was 21.3%, near the double of global population in our country. Among patients with cardiovascular organ damage, COPD was significantly higher (24%). The overall cardiovascular risk in our patients is elevated and nephropathy is the more frequent organ affected by cardiovascular damage. There are no significantly variables that can lead to a better stratification of COPD risk. Underdiagnosis involves one-half of patients with COPD, double in women compared with men, and routine spirometry can reduce it. The most frequent spirometric alteration in our study was the mixed pattern.

Date of Award	27 Oct 2017
Original language	Spanish
Supervisor	Jesus Pedro Recio Iglesias (Director) & Luis José Lores Obradors (Director)