Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo

Análise exploratória de solicitações de autorização para dispensação de medicação de alto custo para portadores de DPOC:

Regina Maria Carvalho-Pinto11,a, Ingredy Tavares da Silva1,2,b, Lucas Yoshio Kido Navacchia1,c, Flavia Munhos Granja1,2,d, Gustavo Garcia Marques1,2,e, Telma de Cassia dos Santos Nery1,f, Frederico Leon Arrabal Fernandes1,g, Alberto Cukier1,h, Rafael Stelmach1,i

J Bras Pneumol.2019;45(6):e20180355-e20180355

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Objective: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting β2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.

 


Keywords: Pulmonary disease, chronic obstructive; Clinical protocols; Drug costs; Tiotropium bromide.

 


Spirometry in patients screened for coronary artery disease: is it useful?

Espirometria em pacientes submetidos a investigação para detecção de doença arterial coronariana: é útil?

Frederico Leon Arrabal Fernandes1,a, Regina Maria Carvalho-Pinto1,b, Rafael Stelmach1,c, João Marcos Salge1,d, Carlos Eduardo Rochitte2,e, Eliane Cardoso dos Santos Souza1,f, Janaina Danielle Pessi1,g, Alberto Cukier1,h

J Bras Pneumol.2018;44(4):299-306

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of spirometric abnormalities in patients screened for coronary artery disease (CAD) and the risk factors for lung function impairment. Methods: Patients referred for cardiac CT underwent spirometry and were subsequently divided into two groups, namely normal lung function and abnormal lung function. The prevalence of spirometric abnormalities was calculated for the following subgroups of patients: smokers, patients with metabolic syndrome, elderly patients, and patients with obstructive coronary lesions. All groups and subgroups were compared in terms of the coronary artery calcium score and the Duke CAD severity index. Results: A total of 205 patients completed the study. Of those, 147 (72%) had normal lung function and 58 (28%) had abnormal lung function. The median coronary artery calcium score was 1 for the patients with normal lung function and 36 for those with abnormal lung function (p = 0.01). The mean Duke CAD severity index was 15 for the former and 27 for the latter (p < 0.01). Being a smoker was associated with the highest OR for abnormal lung function, followed by being over 65 years of age and having obstructive coronary lesions. Conclusions: The prevalence of spirometric abnormalities appears to be high in patients undergoing cardiac CT for CAD screening. Smokers, elderly individuals, and patients with CAD are at an increased risk of lung function abnormalities and therefore should undergo spirometry. (ClinicalTrials.gov identifier: NCT01734629 [http://www.clinicaltrials.gov/])

 


Keywords: Pulmonary disease, chronic obstructive; Spirometry; Coronary disease; Tomography, X-ray computed.

 


Omalizumab in patients with severe uncontrolled asthma: well-defined eligibility criteria to promote asthma control

Omalizumabe em pacientes com asma grave não controlada: critérios de elegibilidade bem definidos para promover o controle da asma

Regina Maria de Carvalho-Pinto1, Rosana Câmara Agondi2, Pedro Giavina-Bianchi2, Alberto Cukier1, Rafael Stelmach1

J Bras Pneumol.2017;43(6):487-489

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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
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