“Yesterday we launched the first study of general practitioners on chronic obstructive pulmonary disease (COPD). The goal is to identify people at risk of COPD – which we know are in particular smokers over 40 years of age – and make a early diagnosis. With Note 99 we can do spirometry “, a reference exam for the disease. This was stated by Claudio Cricelli, president of the Italian Society of General Medicine and Primary Care (Simg) speaking this morning at a meeting on the new recommendations of the latest Gold report (Global initiative on obstructive lung diseases), the most important document for the diagnosis, prevention and treatment of COPD.
As was recalled during the event promoted by Gsk, taking inspiration from the recent Note 99 and from the Gold recommendations, a real life clinical study was developed, i.e. from real life, to photograph, through the data collected by a panel of 40 general practitioners, patient management by the family doctor, for better management of this chronic pulmonary condition which has a strong impact on the quality of life of people, around 3.5 million Italians, and who is responsible for 55% of deaths from respiratory diseases, according to Istat data.
“Note 99 – reminds Claudio Micheletto, UOC director of pulmonology at the Integrated University Hospital of Verona in his speech – opens up a new world for us because it also gives colleagues the faculty to prescribe practically all drugs for Chronic Obstructive Pulmonary Disease (COPD) at with the exception of triple therapy, which remains with the specialist and, moreover, allows the general practitioner to perform spirometry. However, we must build the paths and give a value and a definition of the patient to be treated in the area and in the hospital, defining the path. Even a control spirometry can be important”.
“For years – adds Cricelli – we have known that the naïve (the patient who has never been treated for the disease, Ed.) must be directed to the most effective therapy. But the difficulty of transferring recommendations such as the Golds into practical terms depends on the difficulty of transforming them into lines guide – which have greater importance on clinical application – and by the reluctance of doctors to apply the rules. Yet – reflects the president Simg – by rapidly lowering these rules on the profession, we have an increase in the effectiveness of treatments “.
The question becomes particularly evident also in the light of the data on the reduction of mortality recorded with triple inhalation therapy, recommended by the Gold lines. “Until recently – explains Micheletto – COPD had a therapy that improved symptom control, reduced exacerbations and improved quality of life. Today we have the data on mortality reduction from studies like the Impact. Giving a therapy that impacts on mortality – he continues – can give greater consistency to the therapy for COPD because it does not stop only at the symptoms. It is a prospective figure that will need to be confirmed, but it is important because we could have an impact on a crucial aspect of the disease”.
“On mortality – reiterates Alberto Papi, full professor of respiratory system diseases at the University of Ferrara – I believe that the evidence is substantial. In the Gold report a new chapter was introduced with therapeutic approaches for which there is evidence of reduction of mortality for both pharmacological and non-pharmacological interventions. The Ethos and Impact studies provide solid data, but there are also non-pharmacological interventions such as rehabilitation, oxygen, ventilation, as well as clearly the cessation of smoking – the primary cause of the disease – and surgical interventions for those with emphysema. We can say – he concludes – that we have proven evidence”.
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