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* From the Respiratory Pathology Unit (Dr. Sobradillo), Cruces Hospital, Baracaldo (Biscay); the Pneumology Department (Dr. Miravitlles), Hospital General Vall d'Hebron, Barcelona; the Clinical Epidemiology Unit (Dr. Gabriel), Hospital de la Princesa, Madrid; the Pneumology Department (Dr. Jiménez-Ruiz, MD), Hospital de la Princesa, Madrid; the Pneumology Department (Dr. Villasante), Hospital La Paz, Madrid; the Pneumology Unit (Dr. Masa), Hospital San Pedro de Alcántara, Cáceres; the Pneumology Department (Dr. Viejo), Hospital General Yagüe, Burgos; and the Thoracic Surgery Department (Dr. Fernández-Fau), Hospital de la Princesa, Madrid, Spain.
Correspondence to: Victor Sobradillo Peña, MD, Unidad de Patología Respiratoria, Hospital de Cruces, Plaza de Cruces s/n, Baracaldo. Vizcaya 48903, Spain;
Objectives: To ascertain the prevalence, diagnostic level, and treatment of COPD in Spain through a multicenter study comprising seven different geographic areas.
Design and participants: This is an epidemiologic, multicenter, population-based study conducted in seven areas of Spain. A total of 4,035 men and women (age range, 40 to 69 years) who were randomly selected from a target population of 236,412 subjects participated in the study.
Interventions: Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed, followed by a bronchodilator test when bronchial obstruction was present.
Results: The prevalence of COPD was 9.1% (95% confidence interval [CI], 8.1 to 10.2%), 15% in smokers (95% CI, 12.8 to 17.1%), 12.8% in ex-smokers (95% CI, 10.7 to 14.8%), and 4.1% in nonsmokers (95% CI, 3.3 to 5.1%). The prevalence in men was 14.3% (95% CI, 12.8 to 15.9%) and 3.9% in women (95% CI, 3.1 to 4.8%). Marked differences were observed between sexes in smoking; the percentage of nonsmokers was 23% in men and 76.3% in women (p < 0.0001). The prevalence of COPD varied among the areas, ranging from 4.9% (95% CI, 3.2 to 7.0%) in the area of the lowest prevalence to 18% (95% CI, 14.8 to 21.2%) in the area of the highest. There was no previous diagnosis of COPD in 78.2% of cases (284 of 363). Only 49.3% of patients with severe COPD, 11.8% of patients with moderate COPD, and 10% of patients with mild COPD were receiving some kind of treatment for COPD. Multivariate analysis showed that individuals had a higher probability of having received a previous diagnosis of COPD if they lived in urban areas, were of male gender, were > 60 years old, had higher educational levels, had > 15 pack-year smoking history, or had symptoms of chronic bronchitis.
Conclusions: COPD is a very frequent disease in Spain, and presents significant geographic variations and a very low level of previous diagnosis and treatment, even in the most advanced cases.
Key Words: chronic bronchitis • COPD • epidemiology • prevalence
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