Table 8. Recommendations regarding pharmacological treatment.
| Recommendation | Average value* | Inter-hospital range | P value† |
|---|---|---|---|
| Q22. GesEPOC. Long-acting bronchodilators should be used as first-line treatment in all patients with chronic symptoms | 590 (95.0) | 86.4–100 | 0.001 |
| Q23. GesEPOC. Combinations of long-acting bronchodilators should be considered for COPD patients with persistent symptoms despite monotherapy | |||
| • Use of long-acting bronchodilator combinations | 453 (72.9) | 56.8–84.0 | 0.006 |
| • Use of long-acting bronchodilator combinations among those with indication (n = 102) | 33 (32.4) | 0–47.6 | NS |
| Q24. GOLD 2013. Long-term treatment with inhaled corticosteroids is recommended for patients with severe and very severe COPD and frequent exacerbations not adequately controlled by long-acting bronchodilators | |||
| • Use of treatment with inhaled corticosteroids | 388 (62.5) | 52.1–82.7 | < 0.001 |
| Q25. GOLD 2013. Long-term monotherapy with inhaled corticosteroids is not recommended in COPD | |||
| • Use of monotherapy with inhaled corticosteroids | 1 (0.2) | 0–1.3 | NS |
| Q26. GOLD 2013. The use of antibiotics (other than for treating infectious exacerbations of COPD and other bacterial infections) is not currently indicated | |||
| • Cases not using antibiotics | 602 (96.9) | 93.8–100 | < 0.001 |
| Q27. GOLD 2013. There is some evidence that treatment with mucolytics (such as carbocysteine and N-acetyl-cysteine) may reduce exacerbations in COPD patients not receiving inhaled corticosteroids | |||
| • Use of mucolytics | 53 (8.5) | 0–19.8 | < 0.001 |
| • Use of mucolytics among those not receiving inhaled steroids (n = 174) | 11 (6.3) | 0–22.2 | 0.023 |
| Q28. GOLD 2013. The phosphodiesterase-4 inhibitor, roflumilast, may also be used in patients with chronic bronchitis and severe and very severe COPD, and frequent exacerbations not adequately controlled by long-acting bronchodilators | |||
| • Use of phosphodiesterase-4 inhibitors | 76 (12.2) | 6.2–21.0 | NS |
| • Use of phosphodiesterase-4 inhibitors among those with indication (n = 31) | 12 (38.7) | 0–100 | NS |
* Average value expressed as the mean (standard deviation) or absolute (relative) frequency depending on the nature of the variable.
† Calculated for the variability between centers using ANOVA or Chi-square, depending on the nature of the variable. Percentages refer to the whole population (n = 621) unless otherwise indicated. GOLD 2013: Global Initiative for Obstructive Lung Disease 2013 [19]; SEPAR 2009: SEPAR Health-Care Quality Standards 2009 [21]; GesEPOC 2012: Spanish National Guideline for COPD [22].