Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK

a retrospective study of a clinical cohort

Rupert C M Jones, David Price, Dermot Ryan, Erika J Sims, Julie von Ziegenweidt, Laurence Mascarenhas, Anne Burden, David M G Halpin, Robert Winter, Sue Hill, Matt Kearney, Kevin Holton, Anne Moger, Daryl Freeman, Alison Chisholm, Eric D Bateman, Respiratory Effectiveness Group

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

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.

FUNDING: UK Department of Health, Research in Real Life.

Original languageEnglish
Pages (from-to)267-276
Number of pages10
JournalThe Lancet. Respiratory medicine
Volume2
Issue number4
Early online date13 Feb 2014
DOIs
Publication statusPublished - Apr 2014

Fingerprint

Chronic Obstructive Pulmonary Disease
Retrospective Studies
Comorbidity
Bronchiectasis
Referral and Consultation
Delivery of Health Care
Radiography
Thorax
Asthma
Research
Databases
Spirometry
General Practice
Respiratory System
Prescriptions
Primary Health Care
Patient Care

Cite this

Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK : a retrospective study of a clinical cohort. / Jones, Rupert C M; Price, David; Ryan, Dermot; Sims, Erika J; von Ziegenweidt, Julie; Mascarenhas, Laurence; Burden, Anne; Halpin, David M G; Winter, Robert; Hill, Sue; Kearney, Matt; Holton, Kevin; Moger, Anne; Freeman, Daryl; Chisholm, Alison; Bateman, Eric D; Respiratory Effectiveness Group.

In: The Lancet. Respiratory medicine, Vol. 2, No. 4, 04.2014, p. 267-276.

Research output: Contribution to journalArticle

Jones, RCM, Price, D, Ryan, D, Sims, EJ, von Ziegenweidt, J, Mascarenhas, L, Burden, A, Halpin, DMG, Winter, R, Hill, S, Kearney, M, Holton, K, Moger, A, Freeman, D, Chisholm, A, Bateman, ED & Respiratory Effectiveness Group 2014, 'Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort', The Lancet. Respiratory medicine, vol. 2, no. 4, pp. 267-276. https://doi.org/10.1016/S2213-2600(14)70008-6
Jones, Rupert C M ; Price, David ; Ryan, Dermot ; Sims, Erika J ; von Ziegenweidt, Julie ; Mascarenhas, Laurence ; Burden, Anne ; Halpin, David M G ; Winter, Robert ; Hill, Sue ; Kearney, Matt ; Holton, Kevin ; Moger, Anne ; Freeman, Daryl ; Chisholm, Alison ; Bateman, Eric D ; Respiratory Effectiveness Group. / Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK : a retrospective study of a clinical cohort. In: The Lancet. Respiratory medicine. 2014 ; Vol. 2, No. 4. pp. 267-276.
@article{5e5b9bf3caaa4f3b9d0337f31e8e60e8,
title = "Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort",
abstract = "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.FUNDING: UK Department of Health, Research in Real Life.",
author = "Jones, {Rupert C M} and David Price and Dermot Ryan and Sims, {Erika J} and {von Ziegenweidt}, Julie and Laurence Mascarenhas and Anne Burden and Halpin, {David M G} and Robert Winter and Sue Hill and Matt Kearney and Kevin Holton and Anne Moger and Daryl Freeman and Alison Chisholm and Bateman, {Eric D} and {Respiratory Effectiveness Group}",
note = "Copyright {\circledC} 2014 Elsevier Ltd. All rights reserved.",
year = "2014",
month = "4",
doi = "10.1016/S2213-2600(14)70008-6",
language = "English",
volume = "2",
pages = "267--276",
journal = "The Lancet. Respiratory medicine",
issn = "2213-2600",
publisher = "Elsevier Limited",
number = "4",

}

TY - JOUR

T1 - Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK

T2 - 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 - Respiratory Effectiveness Group

N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.

PY - 2014/4

Y1 - 2014/4

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.FUNDING: UK Department of Health, Research in Real Life.

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.FUNDING: UK Department of Health, Research in Real Life.

U2 - 10.1016/S2213-2600(14)70008-6

DO - 10.1016/S2213-2600(14)70008-6

M3 - Article

VL - 2

SP - 267

EP - 276

JO - The Lancet. Respiratory medicine

JF - The Lancet. Respiratory medicine

SN - 2213-2600

IS - 4

ER -