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espanolIntroduccion. En los ultimos anos se han realizado numerosos avances relacionados con la enfermedad pulmonar obstructiva cronica (EPOC), y sobre todo ha habido frecuentes cambios en las recomendaciones respecto al tratamiento; en concreto sobre la indicacion y uso de corticoides inhalados (CI). Objetivos. El objetivo de este documento es generar recomendaciones actualizadas del uso de los CI con el fin de optimizar el tratamiento de los pacientes que acuden a la consulta de los profesionales de atencion primaria. Material y metodos. Neumologos y medicos de atencion primaria (AP) han participado en este proyecto en todo el territorio nacional, compartiendo experiencias clinicas con el fin de recoger la situacion sobre el manejo de los CI en pacientes con EPOC en cada region, analizando y validando las recomendaciones previamente elaboradas por el Comite Cientifico tras una exhaustiva revision de la evidencia cientifica existente. Resultados. La mayoria de los participantes mostraron su acuerdo con las recomendaciones. Se deberia aumentar la formacion sobre conceptos como exacerbacion de la enfermedad y seguridad de los CI. Es importante individualizar los tratamientos y disminuir la variabilidad de criterios. Hay que aumentar el numero de revisiones periodicas, actualizar los protocolos de tratamiento y hacer hincapie en las recomendaciones de las guias de practica clinica sobre el tratamiento LABA/CI en pacientes ACO (siglas del ingles asthma-COPD overlap)1-4, o con recuento elevado de eosinofilos. Se debe fomentar la implicacion de todos los profesionales sanitarios involucrados en el tratamiento del paciente con EPOC e invertir mas recursos economicos en la educacion sanitaria de los pacientes. Conclusiones. En este proyecto se propone una serie de recomendaciones validadas, discutidas y consensuadas por medicos de AP, en relacion con la correcta identificacion del paciente con EPOC candidato a tratamiento con CI inhalados (paciente exacerbador o ACO) y la seguridad en el uso de estos, que esperamos sean de ayuda en la toma de decisiones de los profesionales sanitarios. EnglishIntroduction. In recent years, many advances have been made related with chronic obstructive pulmonary disease (COPD), and above all frequent changes have taken place in the recommendations regarding its treatment, specifically on the indication and use of inhaled corticosteroids (IC). Objectives. This document aims to generate updated recommendations on the use of ICs in order to optimize the treatment of patients who come to the medical office of the primary care professionals. Materials and methods. Pneumologists and primary care (PC) physicians have participated in this project in all of the national territory, sharing clinical experiences in order to gather information on the situation of the management of ICs in patients with COPD in each region, analyzing and validating the recommendations previously elaborated by the Scientific Committee after a comprehensive review of the existing scientific evidence. Results. The majority of the participants expressed their approval with the recommendations. Training should be increased on concepts such as exacerbation of the disease and safety of the ICs. It is important to tailor the treatments and decrease the variability of criteria. The number of regular reviews needs to be increased as well as the need to update the treatment protocols and to place emphasis on the recommendations of the clinical practice guidelines on the LABA/IC treatment patients with asthma-COPD overlaping1-4 or with elevated eosinophil count. Involvement of all the health care professionals participating in the treatment of the patients with COPD should be encouraged and more economic resources must be invested in the health care education of the patients. Conclusions. A series of validated, discussed and agreed upon recommendations by the PC physicians are proposed in this project in relationship with the correct identification of patients with COPD who are candidates for treatment with inhaled ICs (exacerbator or ACO patients) and the safety of the use of these, which we hope will be of help in the decision making of the health care professionals. |
