Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

Figures & data

Table 1 Patient characteristics

Variables	Average*	Interhospital range	P-value#
Age (years)	68.3 (9.8)	64.7–69.7	0.100
Male sex (n)	527 (84.9)	51.7–94.8	<0.001
Current smokers (n)	163 (26.2)	18.5–40.0	<0.001
Tobacco history (pack-years)	54.7 (30.5)	42.5–66.6	<0.001
Comorbidities (Charlson)	2.15 (1.5)	1.8–2.4	0.577
Psychiatric comorbidities (n)	126 (20.3)	12.3–24.1	0.779
Cardiovascular comorbidities (n)	163 (26.2)	18.2–37.5	0.072
Previous neoplasms (n)	92 (14.8)	8.6–21.0	0.532
Time from diagnosis (years)	5.5 (5.9)	1.06–6.9	0.033
GesEPOC phenotype
Nonfrequent exacerbator (n)	297 (47.8)	0–85.2	<0.001
Mixed (n)	64 (10.3)	3.7–22.5	<0.001
Frequent exacerbator with emphysema (n)	50 (8.1)	0–17.3	<0.001
Frequent exacerbator with chronic bronchitis (n)	90 (14.5)	0–34.2	<0.001
Not available (n)	120 (19.3)	0–88.9	<0.001
GOLD types
Type A (n)	115 (18.5)	0–40.7	<0.001
Type B (n)	60 (9.7)	0–21.9	<0.001
Type C (n)	100 (16.1)	0–38.3	<0.001
Type D (n)	109 (17.6)	0–32.9	<0.001
Not available (n)	237 (38.2)	0–100	<0001
Previous hospitalizations (n)	0.9 (1.6)	0.1–1.3	<0.001
α1-Antitrypsin determined (n)	164 (26.4)	2.5–53.2	<0.001
Some sputum microbiology in the past (n)	264 (42.5)	11.3–64.2	<0.001
Some sputum isolation in the past (n)	23 (3.7)	0–11.1	<0.001
BODE available (n)	60 (9.7)	0–32.5	<0.001
BODEx available (n)	145 (23.3)	0–96.3	<0.001
Body mass index (kg/m^2)	28.2 (5.3)	26.0–29.6	0.009
FVC (%)	74.6 (20.7)	63.7–98.4	<0.001
FEV1 (%)	51.9 (19.7)	42.7–59.1	0.001
Monographic clinic (n)	229 (36.9)	0–100	<0.001
Clinic located in the hospital (n)	607 (97.7)	82.7–100	<0.001

Notes:

* Data are expressed as mean (SD) or absolute (relative) frequencies depending on the nature of the variable.

# Calculated for the variability between centers using ANOVA and Chi-square test, depending on the nature of the variable.

Abbreviations: ANOVA, analysis of variance; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; SD, standard deviation; BODE, body mass index, obstruction, dyspnea, and excercise.

Table 2 Data recorded in the clinical interview

Variables	Average* (n=621)	Interhospital range	P-value#	Autumn (n=179)	Winter (n=144)	Spring (n=175)	Summer (n=123)	P-value‡
Anamnesis
Dyspnea recorded (n)	560 (90.2)	80.8–100	<0.001	154 (86.0)§	136 (94.4)	158 (90.3)	112 (91.1)	0.088
Dyspnea recorded by mMRC scale (n)	489 (78.7)	39.7–100	<0.001	137 (76.5)	125 (86.8)§	138 (78.9)	89 (72.4)	0.028
CAT questionnaire registered (n)	108 (17.4)	0–93.8	<0.001	29 (16.2)	28 (19.4)	30 (17.1)	21 (17.1)	0.893
Clinical situation evaluated by mMRC or CAT	489 (78.7)	39.7–100	<0.001	137 (76.5)	125 (86.8)§	138 (78.9)	89 (72.4)	0.028
Cough and sputum registered (n)	551 (88.7)	62.5–100	<0.001	155 (86.6)	131 (91.0)	154 (88.0)	111 (90.2)	0.590
Sputum color recorded (n)	499 (80.4)	35.0–100	<0.001	135 (75.4)§	121 (84.0)	136 (77.7)	107 (87.0)§	0.042
Asthma-like symptoms recorded (n)	544 (87.6)	50.0–100	<0.001	155 (86.6)	130 (90.3)	152 (86.9)	107 (87.0)	0.741
Previous exacerbations recorded (n)	556 (89.5)	57.5–98.7	<0.001	151 (84.4)§	129 (89.6)	160 (91.4)	116 (94.3)	0.032
Hospitalizations recorded (n)	588 (94.7)	55.0–100	<0.001	161 (89.9)§	137 (95.1)	168 (96.0)	122 (99.2)§	0.003
Current treatments
Smoking status recorded (n)	591 (95.2)	72.4–100	<0.001	164 (91.6)§	137 (95.1)	169 (96.6)	121 (98.4)	0.038
Exercise recorded (n)	403 (64.9)	24.7–100	<0.001	109 (60.9)	104 (72.2)§	114 (65.1)	76 (61.8)	0.159
Influenza vaccination recorded (n)	341 (54.9)	16.0–93.8	<0.001	92 (51.4)	83 (57.6)	100 (57.1)	66 (53.7)	0.625
Pneumococcal vaccination recorded (n)	231 (37.2)	5.0–95.1	<0.001	63 (35.2)	61 (42.4)	57 (32.6)	50 (40.7)	0.243
Current pharmacological treatment recorded (n)	568 (91.5)	53.8–100	<0.001	170 (95.0)§	136 (94.4)	159 (90.9)	103 (83.7)§	0.003
Treatment adherence evaluated (n)	327 (52.7)	3.4–92.6	<0.001	91 (50.8)	75 (52.1)	98 (56.0)	63 (51.2)	0.767
Device satisfaction evaluated (n)	102 (16.4)	0–60.5	<0.001	13 (7.3)§	31 (21.5)	33 (18.9)	25 (20.3)	0.001
Adverse effects recorded (n)	145 (23.3)	4.9–66.7	<0.001	32 (17.9)§	36 (25.0)	52 (29.7)§	25 (20.3)	0.050

Notes:

* Data are expressed as mean (SD) or absolute (relative) frequencies depending on the nature of the variable.

# Calculated for the variability between centers using ANOVA and Chi-square test, depending on the nature of the variable.

‡ Calculated for the variability between seasons using ANOVA and Chi-square test, depending on the nature of the variable.

§ Significant difference (P<0.05) versus the rest of the seasons calculated using a Chi-square test.

Abbreviations: ANOVA, analysis of variance; mMRC, modified Medical Research Council; SD, standard deviation; CAT, COPD assessment test.

Table 3 Complementary diagnostic evaluations requested

Variables	Average* (n=621)	Interhospital range	P-value#	Autumn (n=179)	Winter (n=144)	Spring (n=175)	Summer (n=123)	P-value‡
Chest radiography (n)	426 (68.6)	19.2–100	<0.001	119 (66.5)	103 (71.5)	116 (66.3)	88 (71.5)	0.418
Spirometry (n)	510 (82.1)	52.5–100	<0.001	154 (86.0)	116 (80.6)	143 (81.7)	97 (78.9)	0.389
Computed tomography (n)	96 (15.5)	2.5–37.5	<0.001	28 (15.6)	20 (13.9)	31 (17.7)	17 (13.8)	0.751
Echocardiogram (n)	36 (5.8)	0–9.9	0.325	10 (5.6)	6 (4.2)	10 (5.7)	10 (8.1)	0.584
Sputum eosinophilia (n)	0 (0)	0–0	–	0 (0)	0 (0)	0 (0)	0 (0)	–
Serum total IgE (n)	34 (5.5)	0–17.2	<0.001	13 (7.3)	8 (5.6)	6 (3.4)	7 (5.7)	0.469
Serum α1-antitripsin (n)	53 (8.5)	0–19.8	<0.001	20 (11.2)	18 (12.5)	8 (4.6)§	7 (5.7)	0.026
Sputum culture (n)	53 (8.5)	0–23.4	<0.001	16 (8.9)	13 (9.0)	16 (9.1)	8 (6.5)	0.846
Six-minute walking test (n)	110 (17.7)	0–82.5	<0.001	33 (18.4)	27 (18.8)	26 (14.9)	24 (19.5)	0.700
Shuttle walking test (n)	0 (0)	0–0	–	0 (0)	0 (0)	0 (0)	0 (0)	–
Cardiopulmonary exercise test (n)	3 (0.5)	0–3.4	0.316	2 (1.1)	0 (0)	0 (0)	1 (0.8)	0.344
Densitometry (n)	4 (0.6)	0–5.1	0.001	2 (1.1)	0 (0)	0 (0)	1 (0.8)	0.653
Any other health status questionnaires excluding CAT (n)	0 (0)	0–0	–	0 (0)	0 (0)	0 (0)	0 (0)	–

Notes:

* Data are expressed as mean (SD) or absolute (relative) frequencies depending on the nature of the variable.

# Calculated for the variability between centers using ANOVA and Chi-square test, depending on the nature of the variable.

‡ Calculated for the variability between seasons using ANOVA and Chi-square test, depending on the nature of the variable.

§ Significant difference versus the rest of the seasons.

Abbreviations: ANOVA, analysis of variance; SD, standard deviation; CAT, COPD assessment test.

Table 4 Final treatment-related decisions recommended after the follow-up visit

Variables	Average* (n=621)	Interhospital range	P-value#	Autumn (n=179)	Winter (n=144)	Spring (n=175)	Summer (n=123)	P-value‡
Diagnosis of COPD recorded (n)	603 (97.1)	94.5–100	<0.001	172 (96.1)	140 (97.2)	170 (97.1)	121 (98.4)	0.713
GOLD type identified (n)	224 (36.1)	3.4–100	<0.001	61 (34.1)	52 (36.1)	70 (40.0)	41 (33.3)	0.598
GesEPOC phenotype identified (n)	294 (47.3)	8.6–95.0	<0.001	76 (42.5)	68 (47.2)	94 (53.7)	56 (45.5)	0.193
GOLD or GesEPOC patient type identified (n)	423 (68.1)	13.8–100	<0.001	115 (64.2)	100 (69.4)	129 (73.7)	79 (64.2)	0.192
Detailed treatment recommendations (n)	603 (97.1)	89.7–100	<0.001	173 (96.6)	141 (97.9)	171 (97.7)	118 (95.9)	0.729
Recommendation on smoking (n)	278 (44.8)	8.6–92.6	<0.001	82 (45.8)	58 (40.3)	84 (48.0)	54 (43.9)	0.566
Recommendation on exercise (n)	276 (44.4)	2.5–88.9	<0.001	71 (39.7)	72 (50.0)	81 (46.3)	52 (42.3)	0.269
Recommendation on influenza vaccine (n)	269 (43.3)	2.5–93.8	<0.001	73 (40.8)	52 (36.1)	86 (49.1)	58 (47.2)	0.083
Recommendation on pneumococcal vaccine (n)	116 (18.7)	0–40.7	<0.001	32 (17.9)	24 (16.7)	34 (19.4)	26 (21.1)	0.798
Pharmacological treatment changed (n)	199 (35.2)	10.5–58.0	<0.001	54 (32.0)	49 (36.0)	57 (36.1)	39 (38.2)	0.732
Type of pharmacological change
Increase in the number of drugs (n)	99 (17.5)	5.6–28.4	0.023	26 (15.4)	26 (19.1)	28 (17.7)	19 (18.6)	0.834
Decrease in the number of drugs (n)	55 (9.7)	0–14.5	0.286	18 (10.7)	12 (8.8)	14 (8.96)	11 (10.8)	0.907
Change in drug type (n)	45 (8.0)	0–19.8	0.003	10 (5.9)	11 (8.1)	15 (9.5)	9 (8.8)	0.665
Discharged from the clinic (n)	30 (4.8)	0–16.5	<0.001	6 (3.4)	5 (3.5)	6 (3.4)	13 (10.6)§	0.012

Notes:

* Data are expressed as mean (SD) or absolute (relative) frequencies depending on the nature of the variable.

# Calculated for the variability between centers using ANOVA and Chi-square test, depending on the nature of the variable.

‡ Calculated for the variability between seasons using ANOVA and Chi-square test, depending on the nature of the variable.

§ Significant difference versus the rest of the seasons.

Abbreviations: ANOVA, analysis of variance; COPD, chronic obstructive pulmonary disease; SD, standard deviation.