Highlights of an Expert Advisory Board on Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD) in Latin America

Figures & data

Table 1 Members of the Advisory Board: (A) Advisory Board Scientific Experts from the LATAM Region, (B) GSK Specialists

(A) Lung Specialists from the LATAM Region
Country	Name	Specialty
Argentina	Daniel Colodenco	Former chief of Immunology, Maria Ferrer Hospital Buenos Aires Director of Pulmonology Postgraduate Course, University of Buenos Aires Former president of Argentine Respiratory Association of Respiratory Medicine Co-Director of EPOC.AR Study
	Gustavo Lopardo	Hospital Bernardo Houssay, Buenos Aires Fundacion Centro de Estudios Infectologicos Professor of infectious diseases, Universidad de Buenos Aires
	Pablo O. Rodriguez	Pulmonary and Critical Care Medicine Centro de Educacion Medica e Investigaciones Clinicas (CEMIC)
Brazil	Aldo Agra de Albuquerque Neto	Unidade de Reabilitação Pulmonar, Universidade Federal de São Paulo (Unifesp)
Colombia	Carlos Torres	Director, Research Department, Fundacion Neumologica Colombiana
Mexico	Rafael J. Hernandez Zenteno	Head of COPD Clinic, National Institute of Respiratory Diseases
	Luis Septien	Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Panama	Reynaldo Chandler	Professor of Clinical Pneumology Pneumologist and Clinical Investigator, Hospital San Miguel Arcangel
(B) GSK specialists
Department	Name	Role and Specialty in the Meeting
Regional Medical Affairs and R&D VP LATAM	Eduardo Ortega-Barría	Chairman Infectious disease specialty
Medical Director Caricam Pharma	Jose Romero	Co-chairman Medical doctor
Vaccines Medical Manager	Laura Naranjo	Speaker Facilitator Infectious disease specialty
Epidemiology Regional Manager	Patricia Juliao	Speaker Epidemiologist
Clinical Operations LATAM Head	Bruno Anspach	Observer Timekeeper Clinical research
Clinical and Epidemiology R&D Project Lead	Ashwani Arora	Speaker Clinical research
Epidemiology Regional Manager	Adriana Guzman Holst	Scriber Epidemiologist

Abbreviations: CEMIC, Centro de Educacion Medica e Investigaciones Clinicas; COPD, chronic obstructive pulmonary disease; EPOC.AR, Enfermedad Pulmonar Obstructiva Crónica en Argentina; LATAM, Latin America; R&D, research and development; VP, vice president; Unifesp, Universidade Federal de São Paulo.

Table 2 Literature Review Results

	LATAM Countries/Cities	Study Population	Study Period	Age	Endpoints	Results
Studies
Echazarreta et al, “EPOC.AR”^Citation32	6 urban areas in Argentina	Population-based	2014–2016	≥40 years	COPD spirometric fixed-ratio prevalence^a and LLN prevalence^b Risk factors, clinical and demographic characteristics of COPD	COPD prevalence: GOLD: 14.5% LLN: 9.4% Underdiagnoses rate: 77.4% Diagnosis error rate/false positive COPD diagnosis: 60.7%
					No AE-COPD specific endpoint	No outcome relevant to AE-COPD
Lopez Varela et al, “PUMA”^Citation33	Argentina Colombia Venezuela Uruguay	At-risk^c individuals attending primary care clinics	2012	≥40 years	COPD spirometric fixed-ratio prevalence^a and LLN prevalence^b	Prevalence
								Fixed ratio	LLN
						Overall		20.1%	14.7%
						Argentina		29.6%	19.3%
						Colombia		26.4%	21.8%
						Venezuela		11%	8.3%
						Uruguay		17.5%	13.6%
					No AE-COPD specific endpoint Self-reported exacerbation history was recorded	No outcome relevant to AE-COPD
Miravitlles et al, “EPOCA”^Citation19	Argentina Ecuador	Outpatients with COPD diagnosis^d	2005–2006	>40 years	COPD^d clinical and demographic characteristics, including exacerbations, hospital admission, and emergency visits	COPD patients
						Number of events^e	Argentina (N=128)			Ecuador (N=134)
						Exacerbation	2			0.9
						Emergency visits	1.3			0.3
						Admissions	0.5			0.4
						ICU admissions	0.2			0.0
						Visits to GPs	2.6			1.6
						Visits to chest specialists	4.6			2.8
Caballero et al, “PREPOCOL”^Citation34	Colombia	General population selected by probabilistic method	2003–2004	≥40 years	COPD fixed-ratio spirometric, medical, and clinical prevalence^f	Prevalence (N=5539): Spirometric: 8.9% Medical: 3.3% Clinical: 2.7%
					No AE-COPD specific endpoint	No outcome relevant to AE-COPD
Menezes et al, “PLATINO”^Citation35	São Paulo, Brazil Santiago, Chile Mexico City, Mexico Montevideo, Uruguay Caracas, Venezuela	General population selected by probabilistic method	2002	≥40 years	COPD fixed-ratio spirometric prevalence^a	São Paulo: 15.8% Santiago: 16.9% Mexico City: 7.8% Montevideo: 19.7% Caracas: 12.1%
					No AE-COPD specific endpoint	No outcome relevant to AE-COPD
Systematic Reviews
Ciapponi et al^Citation12	LATAM: Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, Uruguay, Trinidad and Tobago, and Venezuela	Systematic review and meta-analysis on population-based prevalence studies	2012	≥40 years	COPD fixed-ratio prevalence, risk factors, and disease burden^g COPD exacerbations	Pooled prevalence: 13.4% 40–49 years: 5.2% 50–59 years: 11.0% ≥60 years: 24.3% Exacerbations: 50% of the patients 9.5 days median length of hospitalizations

Notes: ^aPost-bronchodilator FEV1/FVC <70%. ^bPost-bronchodilator FEV1/FVC <lower limit of normal. ^cAge ≥40 years, smoker or former smoker of at least 10 packs per year, and/or exposure to biomass smoke. ^dAge>40 years, smoker or former smoker of at least 10 pack years, FEV1/FVC <70%. ^eMean number. ^fFixed-ratio spirometric if FEV1/FVC <70%, medical if there was a history of diagnosis for bronchitis, emphysema, or COPD, and clinical if chronic bronchitis criteria were fulfilled. ^gInvolves disease severity, comorbidities, mortality, cost, and resource utilization.

Abbreviations: AE-COPD, acute exacerbations of chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease; EPOCA, Enfermedad Pulmonar Obstructiva Crónica en Acción; EPOC.AR, Enfermedad Pulmonar Obstructiva Crónica en Argentina; FEV_1, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; GP, general practitioner; ICU, intensive care unit; LATAM, Latin America; LLN, lower limit of normal; PLATINO, Projeto Latino-Americano de Investigação em Obstrução Pulmonar; PREPOCOL, Prevalencia de EPOC [COPD] en Colombia; PUMA, Prevalence Study and Regular Practice, Diagnosis and Treatment, Among General Practitioners in Populations at Risk of COPD in Latin America.

Figure 1 Relevance, aims, and main findings of the study.

EchazarretaAL, AriasSJ, Del OlmoR, et al. Prevalence of COPD in 6 urban clusters in Argentina: the EPOC.AR study. Arch Bronconeumol. 2018;54(5):260–269. doi:10.1016/j.arbres.2017.09.01829221827

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