The OPTI Study in Spain Looks at the History Flare-ups in Patients With Chronic Obstructive Pulmonary Disease (COPD) Treated With Inhaled Steroids.
- Conditions
- Pulmonary Disease, Chronic Obstructive
- Interventions
- Drug: Inhaled corticosteroid
- Registration Number
- NCT03611777
- Lead Sponsor
- Boehringer Ingelheim
- Brief Summary
This non-Interventional, descriptive, cross-sectional cohort and multicentre study will be conducted with COPD patients attended at Spanish Primary Care offices.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 901
- Written informed consent prior to participation
- Female and male patient ≥ 40 years of age
- Chronic Obstructive Pulmonary Disease (COPD) diagnosis more than 2 years before the study visit
- Previously confirmed Chronic Obstructive Pulmonary Disease (COPD) diagnosis (post-bronchodilator FEV1/FVC ratio <70%)
- Clinical data available 2 years before the study visit
- Ability to complete CAT - COPD Assessment Test
- Current participation in any clinical trial involving a drug or device
- A moderate or severe exacerbation (requiring oral corticosteroid, antibiotics or hospitalisation) during the study visit or within 4 weeks before the study visit
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description subjects with Pulmonary Disease, Chronic Obstructive Inhaled corticosteroid -
- Primary Outcome Measures
Name Time Method Percentage of Patients Currently on Inhaled CorticoSteroids (ICS) Who Did Not Have Moderate or Severe Exacerbation in the Year Prior to the Study Visit 1 year prior to study visit, data collected at study visit (1 day). Percentage of patients currently on ICS who did not have moderate or severe exacerbation in the year prior to the study visit, (i.e. within the last 365 days before the study visit). Data related to history and details of exacerbations and ICS treatment, as well as data on current ICS treatment was obtained from medical charts.
Moderate exacerbation: increase in, or new onset of, ≥ 2 respiratory symptoms (cough, sputum, dyspnea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading the patient's attending physician to initiate treatment with systemic corticosteroids and/or antibiotics.
Severe exacerbation: increase in or new onset of ≥ 2 respiratory symptoms (cough, sputum, dyspnoea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading to patient's hospitalization.
- Secondary Outcome Measures
Name Time Method Number of Moderate or Severe Exacerbations in Patients Treated With Inhaled Corticosteroids (ICS) at the Time of Study Visit, Both in Previous 1 Year and Previous 2 Years Before the Study Visit 1 year and 2 years prior to study visit, data collected at study visit. Number of moderate or severe exacerbations in chronic obstructive pulmonary disease (COPD) patients treated with ICS at the time of study visit, both in previous 1 year and previous 2 years before the study visit. Data related to history and details of exacerbations and ICS treatment, as well as data on current ICS treatment was obtained from medical charts.
Moderate exacerbation: increase in, or new onset of, ≥ 2 respiratory symptoms (cough, sputum, dyspnea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading the patient's attending physician to initiate treatment with systemic corticosteroids and/or antibiotics.
Severe exacerbation: increase in or new onset of ≥ 2 respiratory symptoms (cough, sputum, dyspnoea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading to patient's hospitalization.Percentage of Patients Currently on Inhaled CorticoSteroids (ICS) Who Have Had Moderate or Severe Exacerbation in the Year Prior to the Study Visit 1 year prior to study visit, data collected at study visit (1 day). Percentage of patients currently on ICS who have had moderate or severe exacerbation in the year prior to the study visit, (i.e. within the last 365 days before the study visit). Data related to history and details of exacerbations and ICS treatment, as well as data on current ICS treatment was obtained from medical charts.
Moderate exacerbation: increase in, or new onset of, ≥ 2 respiratory symptoms (cough, sputum, dyspnea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading the patient's attending physician to initiate treatment with systemic corticosteroids and/or antibiotics.
Severe exacerbation: increase in or new onset of ≥ 2 respiratory symptoms (cough, sputum, dyspnoea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading to patient's hospitalization.Number of Patients With Adherence to Treatment Recommendations According Spanish COPD Guidelines (GesEPOC) 2017 1 year prior to study visit, data collected at study visit (1 day). Number of patients with adherence to treatment recommendations according GesEPOC 2017 guidelines, stratified by risk and phenotypes.
Adherence: Patients treated with Inhaled CorticoSteroids (ICS) that according to GesEPOC 2017 should had been treated with ICS; Patients not treated with ICS that according to GesEPOC 2017 should not had been treated with ICS.
Non-adherence: Patients treated with ICS but according to GesEPOC 2017 should not have been treated with ICS; Patients not treated with ICS but according to GesEPOC 2017 should have been treated with ICS.
Low risk: Patients with Forced Expiratory Volume in 1st second (FEV1) post bronchodilator ≥50% and Modified Medical Research Council (mMRC) (0-1-2) and with ≤1 moderate/severe exacerbation without hospitalization in the last year.
High risk: Patients with FEV1 post bronchodilator \<50% or mMRC (3-4) and ≥2 moderate/severe exacerbation or severe ≥1 in the last year. Current phenotype was assigned to high risk patients.Percentage of Patients With ICS-related Adverse Events 2 years prior to study visit, data collected at study visit (1 day). Percentage of patients with adverse reactions commonly related to Inhaled CorticoSteroids (ICS), which were predefined in the eCRF and per protocol. In this sense, it could be the case of a patient reporting a commonly ICS-related adverse event, without current treatment with ICS at the time of the study visit. Data were obtained from medical charts. Results were reported for COPD patients overall (both arms combined), as the outcome is not related with the current ICS treatment of a patient.
Percentage of Patients Treated With Inhaled CorticoSteroids (ICS) at the Time of Study Visit With or Without Moderate or Severe Exacerbations, in the Previous 2 Years Before the Study Visit 2 years prior to study visit, data collected at study visit (1 day). Percentage of patients with chronic obstructive pulmonary disease (COPD) treated with Inhaled CorticoSteroids (ICS) at the time of study visit with or without moderate or severe exacerbations, in the previous 2 years before the study visit. Data related to history and details of exacerbations and ICS treatment, as well as data on current ICS treatment was obtained from medical charts.
Moderate exacerbation: increase in, or new onset of, ≥ 2 respiratory symptoms (cough, sputum, dyspnea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading the patient's attending physician to initiate treatment with systemic corticosteroids and/or antibiotics.
Severe exacerbation: increase in or new onset of ≥ 2 respiratory symptoms (cough, sputum, dyspnoea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading to patient's hospitalization.Percentage of Patients Not Treated With Inhaled CorticoSteroids (ICS) at the Time of Study Visit With or Without Moderate or Severe Exacerbations, Both in the Previous 1 Year and Previous 2 Years Before the Study Visit 1 year and 2 years prior to study visit, data collected at study visit (1 day). Percentage of patients with chronic obstructive pulmonary disease (COPD) treated with Inhaled CorticoSteroids (ICS) at the time of study visit with or without moderate or serve exacerbations, both in the previous 1 year and previous 2 years before the study visit. Data related to history and details of exacerbations and ICS treatment, as well as data on current ICS treatment was obtained from medical charts.
Moderate exacerbation: increase in, or new onset of, ≥ 2 respiratory symptoms (cough, sputum, dyspnea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading the patient's attending physician to initiate treatment with systemic corticosteroids and/or antibiotics.
Severe exacerbation: increase in or new onset of ≥ 2 respiratory symptoms (cough, sputum, dyspnoea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading to patient's hospitalization.Number of Moderate or Severe Exacerbations in Patients Not Treated With Inhaled Corticosteroids (ICS) at the Time of Study Visit, Both in Previous 1 Year and Previous 2 Years Before the Study Visit 1 year and 2 years prior to study visit, data collected at study visit. Number of moderate or severe exacerbations in chronic obstructive pulmonary disease (COPD) patients not treated with ICS at the time of study visit, both in previous 1 year and previous 2 years before the study visit.Data related to history and details of exacerbations and ICS treatment, as well as data on current ICS treatment was obtained from medical charts.
Moderate exacerbation: increase in, or new onset of, ≥ 2 respiratory symptoms (cough, sputum, dyspnea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading the patient's attending physician to initiate treatment with systemic corticosteroids and/or antibiotics.
Severe exacerbation: increase in or new onset of ≥ 2 respiratory symptoms (cough, sputum, dyspnoea, wheezing, chest tightness) with ≥ 1 symptom lasting ≥ 3 days and leading to patient's hospitalization.Percentage of Patients Using Rescue Medication 1 year (last year) and 2 years (last 2 years) prior to study visit, data was collected at study visit (1 day). Percentage of patients who used rescue medication (by type of rescue medication) in the last year and in the last two years. This percentage was calculated using as denominator the FAS set and was stratified by ICS treatment in the study visit.
Data was obtained from medical charts.
SABA: Short-acting beta2- agonists \[\*\]: Salbutamol alone, terbutaline alone and salbutamol in combination (IPRATROPIUM BROMIDE /SALBUTAMOL) are included.General Patient Profile - Body Mass Index (BMI) 2 years prior to study visit, data collected at study visit (1 day). General patient profile for patients treated with inhaled corticosteroid (ICS) and patients not treated with ICS - Body Mass Index (BMI).
Weight (in kg) and height (in cm) were collected in the electronic case report form (eCRF). Body Mass Index was calculated (with last measure available): BMI (kg/m\^2) = weight (kg)/ height (m). BMI is categorized into 5 categories according to the World Health Organization (WHO):
Underweight: BMI\< 18.5 kg/m\^2; Normal weight: 18.5 kg/m\^2 ≤ BMI ≤ 25 kg/m\^2; Overweight: 25 kg/m\^2\< BMI ≤ 30 kg/m\^2; Obese: 30 kg/m\^2 \< BMI ≤ 35 kg/m\^2; Severely Obese: BMI \> 35 kg/m\^2.General Patient Profile - Number of Patients by Smoking Habit 2 years prior to study visit, data collected at study visit (1 day). General patient profile for patients treated with inhaled corticosteroids (ICS) and not treated with ICS. Number of patients by smoking habit (non-smoker, smoker, ex-smoker).
General Patient Profile - Time Since Chronic Obstructive Pulmonary Disease (COPD) Diagnosis Data collected at study visit. General patient profile for patients treated with inhaled corticosteroids (ICS) and not treated with ICS - time since COPD diagnosis.
The year of the COPD diagnosis was collected in the electronic case report form (eCRF). The number of years since diagnosis was obtained as the difference between year of study visit and year of COPD diagnosis (+1).General Patient Profile - Body Mass Index, Airflow Obstruction, Dyspnea and Exacerbations (BODEx) Index 2 years prior to study visit, auto-calculated at study visit (1 day). General patient profile for patients treated with inhaled corticosteroids (ICS) and patients not treated with ICS - BODEx index. The BODEx index is used to predict the mortality rate from chronic obstructive pulmonary disease (COPD). The BODEx index was auto-calculated according the information recorded in the eCRF.
It includes the body mass index (BMI), the degree of dyspnea measured with the mMRC (Modified Medical Research Council) scale, the pulmonary function measured with the FEV1 (%) post-bronchodilation and the number of severe exacerbations (only visits to hospital emergencies and admissions are included).
For each item, a score (0-3) is calculated. BODEx index is obtained as the sum of the scores of all items.
The index ranges from 0 to 9, with a higher index indicating a higher risk of death.General Patient Profile - Number of Patients by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 Spirometric Classification 2 years prior to study visit, auto-calculated at study visit. General patient profile for patients treated with inhaled corticosteroids (ICS) and not treated with ICS - Number of patients by GOLD 2019 spirometric classification. GOLD 2019 spirometric classification was auto-calculated according to the information recorded in the eCRF. While the protocol of the study planned to use GOLD 2017 guidelines, guideline updates were expected and it was planned to consider these updates for analysis purposes. For this reason, given that the GOLD 2019 guidelines were updated and effective, this guideline was used for auto-calculation. Spirometric data was collected from clinical records. To determine the severity of all subjects with COPD, patients were categorized into four levels based on their airflow limitation severity (based on post-bronchodilator FEV1 value): Gold 1 (mild): FEV1 (%) ≥ 80% predicted; Gold 2 (Moderate): 50% ≤ FEV1 (%) \< 80% predicted; Gold 3 (Severe): 30% ≤ FEV1 (%) \< 50% predicted; Gold 4 (Very serious): FEV1 (%) \< 30% predicted.
General Patient Profile - Number of Patients by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 Patient Groups 2 years prior to study visit, auto-calculated at study visit. General patient profile for patients treated with inhaled corticosteroids (ICS) and not treated with ICS - Number of patients by GOLD 2019 patient group (group A, group B, group C, group D).
The GOLD 2019 patient group was auto-calculated according the information recorded in the eCRF.
According to GOLD 2019 classification, four different types of patient groups were considered regarding their symptom burden and risk of exacerbation (exacerbations, Modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) scores obtained from the eCRF):
Group A: 0 or 1 exacerbations (not leading to hospital admission) and mMRC 0-1 and CAT \< 10; Group B: 0 or 1 exacerbations (not leading to hospital admission), and mMRC ≥ 2 or CAT ≥ 10; Group C: ≥ 2 exacerbations or ≥ 1 exacerbation leading to hospital admission, and mMRC 0-1 and CAT \< 10; Group D: ≥2 exacerbations or any ≥ 1 exacerbation leading to hospital admission, and mMRC ≥ 2 or CAT ≥ 10.General Patient Profile - COPD Assessment Test (CAT) Score Data measured at study visit. General patient profile for patients treated with inhaled corticosteroids (ICS) and patients not treated with ICS - CAT score.
The CAT score was obtained from the sum of 8 items (cough, mucus, chest pressure, dyspnea, limitation in domestic activities, social limitation, sleep, energy). Each item ranging from 0 (no symptoms) to 5 points (highest symptoms). To obtain a valid score, no missing values or missing answers were allowed. The total score was obtained as the sum of the scores of all items, ranging from 0 - 40.
The score was grouped into two categories:
CAT \<10: Low impact of COPD (Most days are good, the illness prevents the patient from doing one or two things he or she would like, coughing several days a week);CAT ≥10: Medium / high impact of COPD in the patient.General Patient Profile - Number of Patients by Current Chronic Obstructive Pulmonary Disease (COPD) Treatment 2 years prior to study visit, data collected at study visit. General patient profile for patients treated with inhaled corticosteroid (ICS) and patients not treated with ICS: Current COPD treatment (treatment patterns for COPD) according to current treatment on ICS. Reported is the number of patients by current COPD treatment. Data is obtained from medical charts.
LABA: Long-Acting Beta2-Agonist; LAMA: Long-Acting Muscarinic Antagonist; SABA: Short-acting beta2- agonists; SAMA: Short-acting muscarinic antagonist.General Patient Profile - Number of Patients by Modified Medical Research Council (mMRC) Score Data measured at study visit. General patient profile for patients treated with inhaled corticosteroids (ICS) and patients not treated with ICS - mMRC score.
The mMRC score was used to assess severity of breathlessness in chronic obstructive pulmonary disease (COPD) patients.
Patients were asked to answer the breathlessness scale (Mmrc), a single item (0-4) scale assessing current level of dyspnea. The mMRC comprised of five statements that describe almost the entire range of respiratory disability from none (grade 0) to almost complete incapacity (grade 4). A lower (higher) grade is considered a better (worse) outcome.
Grade 0: None severity Grade 1: Mild severity Grade 2: Moderate severity Grade 3: Severe severity Grade 4: Very severe severityGeneral Patient Profile - Number of Patients by Level of Eosinophils 2 years prior to study visit, data collected at study visit (1 day). General patient profile for patients treated with inhaled corticosteroids (ICS) and patients not treated with ICS - level of eosinophils. Reported is the number of patients by category (low number of eosinophils, high number of eosinophils). Data is obtained from medical charts. Eosinophils were collected in cells per microliter (µl) and the categories are defined as followed:
Low number of eosinophils: \< 300 cel/µl; High number of eosinophils: ≥ 300 cel/µl.
Trial Locations
- Locations (168)
CS Las Cabezas de San Juan
🇪🇸Las Cabezas, Sevilla, Spain
CS Virgen de la Estrella 2
🇪🇸Coria Del Río, Sevilla, Spain
CS Puebla de Cazalla
🇪🇸Puebla De Cazalla, Sevilla, Spain
CS San Miguel de Abona
🇪🇸Tenerife, Spain
C.S. Coia Vigo
🇪🇸Vigo, Spain
CAP Trinitat Vella
🇪🇸Barcelona, Spain
Cap Sant Rafael
🇪🇸Barcelona, Spain
CS Aquitania
🇪🇸Madrid, Spain
CS Puerto Lumbreras
🇪🇸Puerto Lumbreras, Murcia, Spain
CS Villaamil
🇪🇸Madrid, Spain
CAP Dr. Carles Ribas
🇪🇸Barcelona, Spain
CS General Fanjul
🇪🇸Madrid, Spain
CS Bedman
🇪🇸Bedman, Jaén, Spain
CS Torredelcampo
🇪🇸Torre Del Campo, Jaén, Spain
CS Tudela Este
🇪🇸Tudela, Navarra, Spain
CS Valdefuentes
🇪🇸Valdefuentes, Cáceres, Spain
CS Santutxu
🇪🇸Bilbao, Spain
CS Las Aguilas
🇪🇸Madrid, Spain
CS Cartaya
🇪🇸Cartaya, Huelva, Spain
CS Entrevias
🇪🇸Madrid, Spain
CS San Fernando Dr. Cayetano Roldán
🇪🇸San Fernando, Cádiz, Spain
CS Son Rullan
🇪🇸Mallorca, Spain
CS Meliana
🇪🇸Meliana, Valencia, Spain
CS Catarroja
🇪🇸Catarroja, Valencia, Spain
CS Malagon
🇪🇸Malagon, Ciudad Real, Spain
C.S. Malvarrosa
🇪🇸Valencia, Spain
CS Ciudad Rodrigo
🇪🇸Ciudad Rodrigo Salamanca, Spain
C.M. Mataró
🇪🇸Mataró, Spain
CS Mansilla de las Mulas
🇪🇸Mansilla De Las Mulas, León, Spain
CS Sancti Spiritus
🇪🇸Sancti Spiritus, Salamanca, Spain
CS Sangüesa
🇪🇸Sangüesa, Navarra, Spain
CS Collado Villalba Estación
🇪🇸Collado Villalba, Madrid, Spain
CS Olivillo
🇪🇸Cádiz, Spain
Consultorio Guargacho
🇪🇸El Monte, Tenerife, Spain
CAP Bellvitge
🇪🇸L'Hospitalet De Llobregat, Barcelona, Spain
CAP Montilivi
🇪🇸Girona, Spain
CS San Miguel Basauri
🇪🇸Elexalde, Bizcaia, Spain
CS Moguer
🇪🇸Moguer Huelva, Spain
CS Montoro
🇪🇸Montoro, Córdoba, Spain
CAP Dr. Vilaseca
🇪🇸Santa Coloma Gramanet, Barcelona, Spain
CAP Josep Masdevall
🇪🇸Figueres, Girona, Spain
CS Neda
🇪🇸Neda, Coruña, Spain
CS Dr. Luengo Rodríguez
🇪🇸Móstoles, Madrid, Spain
CS Novelda
🇪🇸Novelda, Alicante, Spain
CS Panaderas
🇪🇸Fuenlabrada, Madrid, Spain
CS Cuzco
🇪🇸Fuenlabrada, Madrid, Spain
CS Natahoyo
🇪🇸Gijón, Spain
CS Huelva Centro
🇪🇸Huelva, Spain
CS Victoria
🇪🇸Málaga, Spain
Consultorio Gorraiz
🇪🇸Gorráiz, Spain
CS La Bañeza II
🇪🇸La Bañeza, León, Spain
CAP Hostalric
🇪🇸Hostalric, Girona, Spain
CS El Doctoral
🇪🇸Santa Lucía De Tirajana, Las Palmas, Spain
CS Santa María del Camí
🇪🇸Santa Mª Del Camí, Baleares, Spain
C. S. Paterna
🇪🇸Paterna, Valencia, Spain
CS Polinya de Xuquer
🇪🇸Polinya De Xuquer, Valencia, Spain
CS La Carlota
🇪🇸La Carlota, Córdoba, Spain
CS Perello
🇪🇸Sueca, Valencia, Spain
CS La Cañada
🇪🇸La Cañada, Almería, Spain
CS Sueca
🇪🇸Sueca, Valencia, Spain
CS Brújula
🇪🇸Torrejón De Ardoz Madrid, Spain
CS Laredo
🇪🇸Laredo, Cantabria, Spain
CS La Roda
🇪🇸La Roda, Albacete, Spain
CS Zubia
🇪🇸La Zubia, Granada, Spain
CS Titaguas
🇪🇸Titaguas, Valencia, Spain
CS Maspalomas
🇪🇸Las Palmas, Spain
CS Loeches
🇪🇸Loeches, Madrid, Spain
CS Goya
🇪🇸Madrid, Spain
CS Lora del Río Virgen de Setefilla
🇪🇸Lora Del Río, Sevilla, Spain
CS Eras de Renueva
🇪🇸León, Spain
EAP Carmen Calzado
🇪🇸Alcalá De Henares, Madrid, Spain
CS Alcasser
🇪🇸Alcasser, Valencia, Spain
CS La Chopera
🇪🇸Alcobendas, Madrid, Spain
CS Los Barrios
🇪🇸Los Barrios, Cádiz, Spain
CS Pedralba
🇪🇸Pedralba, Valencia, Spain
CS Almonte
🇪🇸Almonte, Huelva, Spain
CS Tacoronte
🇪🇸Tacoronte, Tenerife, Spain
CS Carihuela
🇪🇸Torremolinos, Málaga, Spain
CS Barrio de la Luz
🇪🇸Valencia, Spain
CS Potosí
🇪🇸Madrid, Spain
CS La Doblada
🇪🇸Vigo, Spain
CS Alcalá de Guadaira
🇪🇸Madrid, Spain
CS Abrantes
🇪🇸Madrid, Spain
CS Canal de Panamá
🇪🇸Madrid, Spain
CS Estrecho de Corea
🇪🇸Madrid, Spain
CS Lérez
🇪🇸Pontevedra, Spain
CS Campanar
🇪🇸Valencia, Spain
CS Ingeniero Joaquim Benlloch
🇪🇸Valencia, Spain
CS Repelega
🇪🇸Portugalete, Bizkaia, Spain
CS Castaños
🇪🇸Portugalete, Vizcaya, Spain
CAP María Bernades
🇪🇸Viladecans, Barcelona, Spain
CS Seminario
🇪🇸Zaragoza, Spain
CS Virgen de la Concha
🇪🇸Zamora, Spain
CS Canal Imperial Venecia
🇪🇸Zaragoza, Spain
CS Casablanca
🇪🇸Zaragoza, Spain
C. S. Xunqueira de Ambia
🇪🇸Xunqueira De Ambia, Ourense, Spain
CS Vélez Norte
🇪🇸Vélez, Málaga, Spain
CAP Canaletas
🇪🇸Cerdanyola, Barcelona, Spain
C.S. Jávea
🇪🇸Jávea, Alicante, Spain
EAP - Centre - L´Hospitalet de Llobregat
🇪🇸L'Hospitalet De Llobregat, Barcelona, Spain
CS La Almunia de Doña Godina
🇪🇸La Almunia De Doña Godina, Zaragoza, Spain
CS Bulevar
🇪🇸Jaén, Spain
CS La Línea Poniente
🇪🇸La Línea De La Concepción, Cádiz, Spain
CS San José
🇪🇸Las Palmas, Spain
CS Lucena
🇪🇸Lucena, Córdoba, Spain
CS San Roque
🇪🇸Lugo, Spain
CS Montesa
🇪🇸Madrid, Spain
CS Arroyo Media Legua
🇪🇸Madrid, Spain
CS Villa de Vallecas
🇪🇸Madrid, Spain
CS Huelin
🇪🇸Málaga, Spain
CS Mengibar
🇪🇸Mengibar, Jaén, Spain
CS dos de Mayo
🇪🇸Móstoles, Madrid, Spain
C.S. Osuna
🇪🇸Osuna, Sevilla, Spain
CS Jardinillos
🇪🇸Palencia, Spain
CS Orgiva
🇪🇸Orgiva, Granada, Spain
CS Pintor Oliva
🇪🇸Palencia, Spain
CS Palos de la Frontera
🇪🇸Palos De La Frontera, Huelva, Spain
CS Pilas
🇪🇸Pilas, Sevilla, Spain
CS La Puebla
🇪🇸Palencia, Spain
C.S. Parador
🇪🇸Parador De Las Hortichuelas, Almería, Spain
Consultorio Peñíscola
🇪🇸Peñíscola, Castellón, Spain
CS Port de Pollença
🇪🇸Pollença, Baleares, Spain
CS Puertollano I
🇪🇸Puertollano, Ciudad Real, Spain
CS Rute
🇪🇸Rute, Córdoba, Spain
CS Periurbana Sur
🇪🇸Salamanca, Spain
CS La Cuesta
🇪🇸San Cristóbal La Laguna, Tenerife, Spain
C. S. San Juan
🇪🇸San Juán de Alicante, Spain
CAP Montclar
🇪🇸Sant Boi De Llobregat, Barcelona, Spain
CS Fuentes Norte
🇪🇸Zaragoza, Spain
CAP Casanova
🇪🇸Barcelona, Spain
CS Covadonga
🇪🇸Torrelavega, Cantabria, Spain
CAP Abrera
🇪🇸Abrera, Barcelona, Spain
CS A Pontenova
🇪🇸A Pontenova, Lugo, Spain
CS Zona IV
🇪🇸Albacete, Spain
CS Nuestra Señora de la Oliva
🇪🇸Alcalá De Guadaira, Sevilla, Spain
CS Zona VI
🇪🇸Albacete, Spain
CS Algemesi
🇪🇸Algemesi, Valencia, Spain
CS Argamasilla de Calatrava
🇪🇸Argamasilla De Calatrava, Ciudad Real, Spain
CS Algeciras Norte
🇪🇸Algeciras, Cádiz, Spain
CAP Sants
🇪🇸Barcelona, Spain
CS Baltar Sanxenxo
🇪🇸Baltar, Pontevedra, Spain
Consultorio Alpuente
🇪🇸Alpuente, Valencia, Spain
CAP Sant Marti (EAP Verneda Nord)
🇪🇸Barcelona, Spain
CAP Chafarinas
🇪🇸Barcelona, Spain
CAP Casernes
🇪🇸Barcelona, Spain
EAP Vía Roma
🇪🇸Barcelona, Spain
EAP Guinardo
🇪🇸Barcelona, Spain
Consultorio Médico Begíjar
🇪🇸Begíjar, Jaén, Spain
Consultorio Bañaderos
🇪🇸Bañaderos, Las Palmas, Spain
CS Benigánim
🇪🇸Benigánim, Valencia, Spain
C. S. Benimamet
🇪🇸Benimamet, Valencia, Spain
CS Matrona Antonia Mesa Fernández
🇪🇸Cabra, Córdoba, Spain
CS Comuneros
🇪🇸Burgos, Spain
CS Gamonal Antigua
🇪🇸Burgos, Spain
C.S. Carballo
🇪🇸Carballo, A Coruña, Spain
C.S. Callosa del Segura
🇪🇸Callosa De Segura, Alicante, Spain
CS Nuestra señora de Gracia
🇪🇸Carmona, Sevilla, Spain
C.S. San Agustín
🇪🇸Castellón, Spain
CS Chapela
🇪🇸Chapela, Pontevedra, Spain
CS Jaime Vera
🇪🇸Coslada, Madrid, Spain
CS Cuenca IV
🇪🇸Cuenca, Spain
CS Puerto de Santa María Sur
🇪🇸El Puerto De Santa María, Cádiz, Spain
C.S. Cuntis
🇪🇸Cuntis, Pontevedra, Spain
CS Lobillas
🇪🇸Estepona, Málaga, Spain
CAP Pubilla Casas
🇪🇸Esplugues De Llobregat, Barcelona, Spain
CAP Figueres Ernest Lluch
🇪🇸Figueres, Girona, Spain
CS Favara
🇪🇸Favara, Valencia, Spain
C. S. Almassera de Tonda, Vila Joiosa
🇪🇸Vila Joiosa, Alicante, Spain