The three years of the Sars-CoV-2 pandemic have not only said that we are vulnerable and that some – the elderly, the frail – are more vulnerable than others. They also made us discover the importance of our breathing and that we need to pay attention to the health of our lungs. This is the first data that catches the eye when analyzing the survey conducted by Doxa Pharma on 100 pulmonologists to see if (and how) Covid has changed the perception – and consequently the behavior – of respiratory diseases in the Italian population, and particularly COPD.
41% of those interviewed – according to a note – declare that visits to the clinic in the post-emergency period have increased and 46% that the reason is due precisely to a greater awareness of the disease, while another 20% say that pushing the patient to the specialist is the fear of complications. Exacerbations are in fact a decisive watershed in the decline of respiratory capacity. So much so that the international Gold 2023 recommendations even suggest the need to prescribe the maximum therapy, the triple therapy, already after the first episode.
The other fact that is worth immediately focusing on is the gender difference. Women (35% of patients vs 65% of males) are better than men, but this is nothing new. They have a shorter history of illness: 9 years compared to 12. They have a less serious condition and comorbidities: mood disorders and osteoporosis, while men suffer mainly from cardiovascular diseases and diabetes. What makes the difference is that women become worried at the first symptoms (41% compared to 11% of men); they are more attentive to their health (here the gap is more marked: 62% vs 22%); to the doctor’s prescriptions and advice (39% compared to 21%), they are treated better (39% – 24%). The third element that emerges from the study – continues the note – is that COPD is not a disease for old people. The habit of smoking and the precociousness in lighting up a cigarette (and we will see the consequences of surrogates shortly) has lowered the age of diagnosis to 50 years.
Around the world, more than half a billion people live with chronic respiratory diseases such as asthma, COPD, bronchiectasis and other serious diseases. In Italy – the note details – there are 2.6 million who suffer from asthma, 3.3 million from COPD, more than 50 thousand have lower respiratory tract infections and over 60 thousand suffer from lung cancer. Therefore, we are faced with the third cause of death on the planet, with an estimate of more than 50 thousand deaths per year. Which equates to direct and indirect costs of 45.7 billion euros (medical care, loss of working days, decreased productivity and consumption of drugs and oxygen). Numbers are increasing, due to the progressive aging of the population and the growing number of smokers. According to data from the Report on Smoking in Italy by the Higher Institute of Health, presented on the occasion of World No Tobacco Day, almost one in 4 Italians, 24.2%, is a smoker: a percentage that has not been recorded since 2006. .
The pandemic has therefore awakened some attention. And this is certainly a good thing. But the picture that Doxa Pharma shows presents large shades of grey. Let’s continue the story. Eight out of 10 pulmonologists confirm that Covid has brought about a change in the management and treatment of COPD patients. The biggest problems are follow-up (57%); referring patients to their attention (42%); the diagnosis (28%). Greater awareness or apprehension has, on the other hand, changed the doctor-patient relationship for 40% of those interviewed. Patient who first asks to be reassured: 23% of clinicians say this; undergoes checks more frequently (10%); also through telemedicine (13%).
For 6 out of 10 pulmonologists the most negative notes come from the ‘patient journey’. Despite a greater demand for diagnostic tests (18%), there are still long waiting times (38%) and difficulties in accessing spirometry (18%). And this is what patients’ requests are based on: reduction of waiting lists (42%), resumption of adequate follow-up (21%), the eternal theme of early diagnosis (15%). For specialists, the priority is to increase monitoring (35%), spirometry first of all, but also other tests; reduce waiting times for visits (30%). It is worth highlighting the hope of 16% for a more central role of the general practitioner. Not only. 79% believe that it is necessary to structure a care network that sees the close collaboration of local healthcare with hospital healthcare. The same percentage, consistently – concludes the note – thinks that it is a good idea to rethink local healthcare and the related methods of taking care of patients with COPD. One in two also looks at digital tools and adequate infrastructures to be able to provide adequate support and responses to patients. Women are mainly treated with double bronchodilation (Laba+Lama), men with triple (Ics+Laba+Lama).
