HEALTH / XX EPOC meeting of the Spanish Society of Internal Medicine

Internal medicine physicians re-emphasise the importance of a holistic approach to COPD and tackling underdiagnosis through ‘active case finding’

It is a chronic disease that manifests itself in outbreaks (exacerbations), the main symptom of which is dyspnea. It classically affects men over the age of 40, although it is increasingly being found in women as well.

COPD patients cared for by internists are usually patients over 80 years of age and with several co-morbidities: high blood pressure, diabetes mellitus or heart failure, etc. They are patients with a higher degree of complexity than those treated in other services

Smoking is the main cause of COPD, although there are others, such as biomass burning, exposure to environmental pollution and, less commonly, genetic causes (1%). More and more cases are diagnosed in people exposed to tobacco smoke (secondhand smoke)

In women, COPD “debuts at an earlier age and causes more symptoms.” It is estimated that there are 500,000 women in Spain with undiagnosed COPD

Caring for these patients requires a multidisciplinary and complex approach, so the work of the internist, as a specialist with a global vision, is key. Internal wards are responsible for the largest number of hospital discharges due to COPD exacerbations according to SNS data (39.03%)

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic pathologies in adults in Spain, affecting 11.8% of people over 40 years of age. However, there is a high rate of underdiagnosis, exceeding 70% in men and up to 80% in women. It is estimated that there are more than 500,000 women with COPD who have not been diagnosed in our country.

These are some of the data that were highlighted at the XV meeting of the COPD working group that the Spanish Society of Internal Medicine (SEMI) organized in Valencia last Thursday and Friday, 29 and 30 September. This meeting brought together internists from all over the country to discuss the main developments in the epidemiology, diagnosis and treatment of COPD, both in the stable phase and in exacerbations or outbreaks of this disease, as well as other aspects related to therapeutic adherence and related comorbidities . During it, special emphasis was placed on “the importance of early detection of COPD and the multidisciplinary approach to the disease”.

Caring for these patients requires a multidisciplinary approach in which the patient’s needs, generally complex, are fully addressed, so the work of the internist, as a specialist with a global vision, is essential. It is not for nothing that Internal Medicine is the hospital service that registers the most patients discharged from the SNS with a diagnosis of COPD (39.03%).

The main profile of patients with COPD in internal medicine is precisely that of a man over 80 years of age and with several comorbidities (hypertension, diabetes mellitus, heart failure, anemia and kidney disease, among others), although this profile is changing.

In the words of Dr. Belen Alonso Ortiz, coordinator of the COPD group of the Spanish Society of Internal Medicine (SEMI): “more and more women are admitted to COPD hospitalization units (or wards) and at a younger age in compared to men,” he points out, after pointing out that “the face of COPD is changing according to the different epidemiological studies in our setting (Europe and the US).” In women, COPD “presents significant differences, debuts at an earlier age and causes more symptoms,” says Dr. Alonso.

Shortness of breath is the main and most limiting symptom of this disease. The progression of the disease and the fact that you have had a respiratory infection in the previous 12 months increases the risk of developing exacerbations (exacerbations) and hospitalizations, in addition to contributing to poor quality of life, lack of activity and poor physical condition after discharge from the hospital.

In terms of triggers, smoking is the main cause of COPD in the Western world, causing harmful effects and favoring the development of related diseases, such as cardiovascular or cerebrovascular diseases. In addition to the genetic predisposition itself, there are other factors to consider, such as “exposure to biomass burning (firewood and others), environmental pollution from large cities or second-hand smoke”.

COPD is a chronic disease that manifests itself in outbreaks (exacerbations). A virus (of course, COVID-19) or bacterial infections and/or heart failure are known to be the most common triggers. Other diseases can decompensate COPD, such as anemia or poor pain control due to osteoporotic vertebral fractures.

The meeting also mentioned the challenge that it will be to care for increasingly complex COPD patients with more co-morbidities in hospitals, given the longer life expectancy thanks to the development of more effective treatments and better inhalation devices . In this sense, the role of the internist will continue to be “very important, both in the treatment of these patients in the exacerbation phases and in the stable phases of the disease”.

Other topics were discussed during the meeting, such as: the impact of COVID-19 on our COPD patients or the binomial of nutrition and COPD, which is little addressed by the clinical field, unlike what happens in the approach to other chronic pathologies, despite the fact that adequate nutritional intake is beneficial for improving muscle strength and exercise tolerance in the context of respiratory pathology.

New technologies and COPD (applications such as iCODEX promoted by internists from EPOC GT at SEMI) or the use of chest ultrasound in the approach to patients with COPD were also discussed, as well as the reactivation after the pandemic of the ADEG-EPOC study promoted by herself workgroup.

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