TY - JOUR
T1 - Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort
AU - Jones, Rupert C. M.
AU - Price, David
AU - Ryan, Dermot
AU - Sims, Erika J.
AU - von Ziegenweidt, Julie
AU - Mascarenhas, Laurence
AU - Burden, Anne
AU - Halpin, David M. G.
AU - Winter, Robert
AU - Hill, Sue
AU - Kearney, Matt
AU - Holton, Kevin
AU - Moger, Anne
AU - Freeman, Daryl
AU - Chisholm, Alison
AU - Bateman, Eric D.
AU - AUTHOR GROUP
AU - an den Berge, Maarten
AU - Anzueto, Antonio
AU - Augusti, Alvar
AU - Bafadhel, Mona
AU - Backer, Vibeke
AU - Barnes, Peter J.
AU - Becker, Allan
AU - Bjermer, Leif
AU - Brightling, Chris
AU - Brusselle, Guy
AU - Buist, Sonia
AU - Calverley, Peter
AU - Chavannes, Niels H.
AU - Christoff, George
AU - Bacharier, Leonard B.
AU - Blakey, John
AU - Bosnic-Anticevich, Sinthia
AU - Bousquet, Jean
AU - Briggs, Andy
AU - Brown, Randall
AU - Campbell, Jonathan
AU - Chystyn, Henry
AU - Clark, Noreen M.
AU - Colice, Gene
AU - Dima, Alexandra
AU - Eakin, Michelle N.
AU - Eid, Nemr
AU - Ericksson, Göran
AU - Griggs, Andy
AU - Gryffudd-Jones, Kevin
AU - Guilbert, Theresa
AU - Haughney, John
AU - Heaney, Liam
AU - van Aalderen, Wim
PY - 2014
Y1 - 2014
N2 - Background Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. Methods We did a retrospective analysis of a clinical cohort in the UK with data from Jan 1, 1990 to Dec 31, 2009 (General Practice Research Database and Optimum Patient Care Research Database). We assessed patients aged 40 years or older who had an electronically coded diagnosis of COPD in their primary care records and had a minimum of 3 years of continuous practice data for COPD (2 years before diagnosis up to a maximum of 20 years, and 1 year after diagnosis) and at least two prescriptions for COPD since diagnosis. We identified missed opportunites to diagnose COPD from routinely collected patient data by reviewing patterns of health-care use and comorbidities present before diagnosis. We assessed patterns of health-care use in terms of lower respiratory consultations (infective and non-infective), lower respiratory consultations with a course of antibiotics or oral steroids, and chest radiography. If these events did not lead to a diagnosis of COPD, they were deemed to be missed opportunities. This study is registered with ClinicalTrials.gov, number NCT01655667. Findings We assessed data for 38 859 patients. Opportunities for diagnosis were missed in 32 900 (85%) of 38 859 patients in the 5 years immediately preceding diagnosis of COPD; in 12 856 (58%) of 22 286 in the 6-10 years before diagnosis, in 3943 (42%) of 9351 in the 11-15 years before diagnosis; and in 95 (8%) of 1167 in the 16-20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0 . 05 years of age per year, 95% CI 0.03-0.07) and yearly frequency of lower respiratory prescribing consultations (rate ratio 0 . 982 opportunities per year, 95% CI 0.979-0.985). Prevalence of all comorbidities present at COPD diagnosis increased except for asthma and bronchiectasis, which decreased between 1990 and 2007, from 281 (33 . 4%) of 842 patients to 451 of 1465 (30 . 8%) for asthma, and from 53 of 842 (6 . 3%) to 53 of 1465 (3 . 6%) for bronchiectasis. In the 2 years before diagnosis, of 6897 patients who had had a chest radiography, only 2296 (33%) also had spirometry. Interpretation Opportunities to diagnose COPD at an earlier stage are being missed, and could be improved by case-finding in patients with lower respiratory tract symptoms and concordant long-term comorbidities
AB - Background Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. Methods We did a retrospective analysis of a clinical cohort in the UK with data from Jan 1, 1990 to Dec 31, 2009 (General Practice Research Database and Optimum Patient Care Research Database). We assessed patients aged 40 years or older who had an electronically coded diagnosis of COPD in their primary care records and had a minimum of 3 years of continuous practice data for COPD (2 years before diagnosis up to a maximum of 20 years, and 1 year after diagnosis) and at least two prescriptions for COPD since diagnosis. We identified missed opportunites to diagnose COPD from routinely collected patient data by reviewing patterns of health-care use and comorbidities present before diagnosis. We assessed patterns of health-care use in terms of lower respiratory consultations (infective and non-infective), lower respiratory consultations with a course of antibiotics or oral steroids, and chest radiography. If these events did not lead to a diagnosis of COPD, they were deemed to be missed opportunities. This study is registered with ClinicalTrials.gov, number NCT01655667. Findings We assessed data for 38 859 patients. Opportunities for diagnosis were missed in 32 900 (85%) of 38 859 patients in the 5 years immediately preceding diagnosis of COPD; in 12 856 (58%) of 22 286 in the 6-10 years before diagnosis, in 3943 (42%) of 9351 in the 11-15 years before diagnosis; and in 95 (8%) of 1167 in the 16-20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0 . 05 years of age per year, 95% CI 0.03-0.07) and yearly frequency of lower respiratory prescribing consultations (rate ratio 0 . 982 opportunities per year, 95% CI 0.979-0.985). Prevalence of all comorbidities present at COPD diagnosis increased except for asthma and bronchiectasis, which decreased between 1990 and 2007, from 281 (33 . 4%) of 842 patients to 451 of 1465 (30 . 8%) for asthma, and from 53 of 842 (6 . 3%) to 53 of 1465 (3 . 6%) for bronchiectasis. In the 2 years before diagnosis, of 6897 patients who had had a chest radiography, only 2296 (33%) also had spirometry. Interpretation Opportunities to diagnose COPD at an earlier stage are being missed, and could be improved by case-finding in patients with lower respiratory tract symptoms and concordant long-term comorbidities
U2 - https://doi.org/10.1016/S2213-2600(14)70008-6
DO - https://doi.org/10.1016/S2213-2600(14)70008-6
M3 - Article
C2 - 24717623
SN - 2213-2600
VL - 2
SP - 267
EP - 276
JO - lancet. Respiratory medicine
JF - lancet. Respiratory medicine
IS - 4
ER -