In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.

A thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice. The Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient, center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (60–80%), adequate (40–59%), inadequate (20–39%), and highly inadequate (< 20%). During the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%). The results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.

Background: Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it. Methods: The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models. Results: During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis. Conclusions: The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement.

The real burden of community-acquired pneumonia (CAP) in non-hospitalized patients is largely unknown. This is a 3-year prospective, observational study of ambulatory CAP in adults, conducted in 24 Spanish primary care centers between 2016–2019. Sociodemographic and clinical variables of patients with radiographically confirmed CAP were collected. Pneumococcal etiology was assessed using the Binax Now^® test. Patients were followed up for 10 ± 3 days. A total of 456 CAP patients were included in the study. Mean age was 56.6 (±17.5) years, 53.5% were female, and 53.9% had ≥1 comorbidity. Average incidence of CAP was 1.2–3.5 cases per 1000 persons per year. Eighteen patients (3.9%) were classified as pneumococcal CAP. Cough was present in 88.1% of patients at diagnosis and fever in 70.8%. Increased pulmonary density (63.3%) and alveolar infiltrates with air bronchogram (16.6%) were the most common radiographic findings. After 14.6 ± 6.0 days (95% CI = 13.9–15.3), 65.4% of patients had recovered. Hospitalization rate was 2.8%. The most frequently prescribed antibiotics were quinolones (58.7%) and β-lactams (31.1%). In conclusion, one-third of CAP patients did not fully recover after two weeks of empiric antibiotic therapy and 2.8% required hospitalization, highlighting the significant burden associated with non-hospitalized CAP in Spain.