OBJECTIVES: Integration, universality, and equity are the principles that guide the National Health system in Brazil (SUS). The estimated prevalence of chronic obstructive pulmonary disease (COPD) could be approximately 17% in Brazil. Despite the existence of a Clinical Guidelines (CG) for COPD management, delivering the recommended treatments to the entire Brazilian population (over 200 million inhabitants distributed across 5570 cities) can be a challenge. This research aims to evaluate the population's access to treatments outlined in the COPD CG across the Brazilian’s geographic regions, also stratifying according to the Average of Human Development Index (A-HDI) in municipalities.

METHODS: Outpatient data from the Data SUS (SUS database), was used, during the years 2017-2019 and 2022-2023, omitting 2020-2021 due to potential COVID-19 impact. The A-HDI of each municipality was used as a stratification criterion for comparing the results. The main outcomes were the access to health technologies from the CG and consistency to drug dispensation. Consistency was defined as recurrent dispensing within a two-month tolerance. Since the data is available through open access, anonymized for patient privacy, ethical approval was not required.

RESULTS: 252,463 patients were identified, with 136,061 (53.9%) being female. There were 15,975,780 dispensations of drugs recommended in COPD CG. South region had the highest prevalence with 156.9 patients/100,000 inhabitants. Patients in municipalities with the lowest A-HDI had worse access to therapies (72.6%) and dispensation consistency (44.7%) compared to those in the highest A-HDI (78.1% and 51.3%, respectively), with both comparisons being statistically significant (p-value < 0.001).

CONCLUSIONS: This research showed that lower A-HDI is linked to worse dispensation consistency and access to treatments, not complying with SUS's equity principle. Additionally, the 252,463 patients identified are below the estimated prevalence, highlighting underreporting and underdiagnosis of COPD in Brazil.