Maite Lamban

Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain

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Publications (6)5.33 Total impact

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    ABSTRACT: To investigate the use and interpretation of spirometry in primary care (PC) in the diagnosis of chronic obstructive pulmonary disease (COPD) and to identify the treatment schedules administered. An observational study was performed in a randomized sample of 251 PC physicians including 2130 patients with COPD. Data on the performance of spirometry and the results and the treatment administered were collected as were sociodemographic and clinical data. Spirometric results were obtained in 1243 (58.4%). Most (1118/1243; 89.9%) corresponded to FEV1 (%) values with a mean of 57% (SD=21.5%). It is of note that only 31.8% of spirometric results provided post-bonchodilator results, and 42.9% and 43.1% of the spirometries presented not plausible FVC or FEV1 values, respectively. Treatment varied greatly, with more than 3 drugs being prescribed in 30.6% of the cases. Long-acting beta-2 agonists and inhaled corticosteroids were prescribed in more than 50% of the patients. Tiotropium was administered in 32.4%. According to the GOLD guidelines, 22.8% of the patients in GOLD II, 50% in III and 66.7% in IV were receiving incorrect treatment. Only 58.4% of the cases included had undergone spirometry. Important deficiencies were observed in the interpretation of the results of spirometry. These difficulties may influence the low implementation of treatment guidelines in COPD in PC.
    Respiratory Medicine 09/2007; 101(8):1753-60. · 2.59 Impact Factor
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    ABSTRACT: The aim of this study was to assess the use of spirometry for the diagnosis and follow-up of patients with chronic obstructive pulmonary disease (COPD) in primary care in terms of deficiencies and the requirements for its correct use, and to identify the regimens most commonly used in patients with COPD. The study included 839 primary care physicians, each of whom completed 2 questionnaires, one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease. Notable among the results was the high number of questionnaires in which no response was given to the question on classification of patients according to the severity of airway obstruction (10.7% of cases) and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD (15.1%). The highest rate of correct responses was for questions regarding the indication for spirometry, all of which were answered correctly in more than 60% of cases. Only 59.2% of primary health care centers performed spirometry, mainly due to a lack of training. In more than 30% of cases the nursing staff had not received specific training, a finding that was reflected in the poor compliance with guidelines for calibration (10.9% of health care centers performed daily calibrations), cleaning of the spirometer (in 13.9% of cases the equipment was never cleaned), and providing patients with pretest recommendations (30% did not provide recommendations the day before spirometry). Primary care physicians are aware of the usefulness of spirometry for the diagnosis and follow-up of COPD. Although they are able to recognize airflow obstruction, they do not classify patients correctly in terms of severity. Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique, a finding reflected in the poor compliance with guidelines for its use.
    Archivos de Bronconeumología 01/2007; 42(12):638-44. · 1.37 Impact Factor
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    ABSTRACT: Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results. A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated. COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09). There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.
    Archivos de Bronconeumología 02/2006; 42(1):3-8. · 1.37 Impact Factor
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    ABSTRACT: ObjectiveAlthough the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results.MethodA representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated.ResultsCOPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09).ConclusionsThere is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.ObjetivoLa prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado en el sexo feme-nino, pero aún se considera una enfermedad que afecta so-bre todo a los varones. Este estudio pretendió identificar las actitudes diagnósticas de los médicos de atención primaria frente a pacientes con EPOC según su sexo y los resultados de la espirometría.MétodosParticipó en el estudio una muestra representa-tiva de 839 médicos de atención primaria. Cada uno de ellos resolvió uno entre 8 casos posibles de pacientes con EPOC. La mitad de éstos correspondía a un paciente varón y la otra mitad a una mujer con historia clínica y exploración fí-sica idénticas. Tras la historia y la exploración física se soli-citó a los participantes un diagnóstico provisional, así como las pruebas diagnósticas necesarias. Se facilitaron después los resultados de la espirometría que mostraban una obstrucción de carácter moderado o grave. Los resultados ne-gativos de una prueba broncodilatadora y de una prueba con corticoides orales se dieron a continuación.ResultadosLa EPOC fue un diagnóstico provisional más probable para los pacientes varones que para las muje-res (odds ratio [OR]: 1,55; intervalo de confianza [IC] del 95%, 1,15-2,1). Este sesgo desaparecía después de mostrar los resultados anormales de la espirometría. Los pacientes con una obstrucción de carácter grave eran diagnosticados con mayor probabilidad de EPOC que aquellos con una obstrucción moderada OR: 1,5; IC del 95%, 1,08-2,09).ConclusionesExiste un sesgo diagnóstico en función del sexo del paciente. En muchas ocasiones no se diagnostica a los pacientes con EPOC que presentan una obstrucción moderada. Estos sesgos podrían comprometer el diagnóstico precoz de la EPOC en un grupo cada vez más frecuente de individuos en riesgo.
    Archivos de Bronconeumología ((English Edition)). 01/2006;
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    ABSTRACT: Objective Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results. Methods A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated. Results COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09). Conclusions There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.
    Archivos de Bronconeumología. 01/2006; 42(1):3–8.
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    ABSTRACT: ObjetivoEl objetivo del estudio ha sido evaluar las deficiencies y necesidades para la correcta utilización de la espirometría en el diagnóstico y seguimiento del paciente con enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria (AP) y conocer las pautas habituales de tratamiento de esta enfermedad.MétodosParticiparon 839 médicos de AP y cada uno de ellos cumplimentó 2 cuestionarios, uno sobre el tratamiento de la EPOC y otro de utilización de la espirometría en su diagnóstico y seguimiento.ResultadosDestacó el bajo índice tanto de respuestas a la pregunta sobre la clasificación de los pacientes en función de la gravedad de la obstrucción (no respondió el 10,7%) como de respuestas correctas en las preguntas sobre el tratamiento broncodilatador en fase estable (respuestas correctas: 15,1%). Las mayores tasas de respuestas correctas se obtuvieron en las preguntas referentes a la indicación de la espirometría, todas ellas con un índice de acierto superior al 60%.Sólo un 59,2% de los centros de AP realizaban espirometrías, sobre todo debido a la falta de formación. En más de un 30% de los casos el personal de enfermería no había recibido formación específica, lo que se reflejaba en un escaso seguimiento de las normativas en cuanto a calibración (un 10,9% de los centros la realizaba diariamente), limpieza de los aparatos (un 13,9% no la hacía nunca) y recomendaciones al paciente (un 30% no daba recomendaciones el día antes).ConclusionesLos médicos de AP conocen la utilidad de la espirometría en el diagnóstico y seguimiento de la EPOC. Identifican la presencia de una obstrucción al flujo aéreo, pero no se clasifica correctamente a los pacientes en función de su gravedad. Se ha observado una escasa disponibilidad de la espirometría en los centros de AP, así como una escasa formación en su manejo, lo que se refleja en un escaso seguimiento de las normativas de realización de la prueba.ObjectiveThe aim of this study was to assess the use of spirometry for the diagnosis and follow-up of patients with chronic obstructive pulmonary disease (COPD) in primary care in terms of deficiencies and the requirements for its correct use, and to identify the regimens most commonly used in patients with COPD.MethodsThe study included 839 primary care physicians, each of whom completed 2 questionnaires, one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease.ResultsNotable among the results was the high number of questionnaires in which no response was given to the question on classification of patients according to the severity of airway obstruction (10.7% of cases) and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD (15.1%). The highest rate of correct responses was for questions regarding the indication for spirometry, all of which were answered correctly in more than 60% of cases. Only 59.2% of primary health care centers performed spirometry, mainly due to a lack of training. In more than 30% of cases the nursing staff had not received specific training, a finding that was reflected in the poor compliance with guidelines for calibration (10.9% of health care centers performed daily calibrations), cleaning of the spirometer (in 13.9% of cases the equipment was never cleaned), and providing patients with pretest recommendations (30% did not provide recommendations the day before spirometry).ConclusionsPrimary care physicians are aware of the usefulness of spirometry for the diagnosis and follow-up of COPD. Although they are able to recognize airflow obstruction, they do not classify patients correctly in terms of severity. Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique, a finding reflected in the poor compliance with guidelines for its use.
    Archivos de Bronconeumología. 01/2006;