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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: A retrospective study of a clinical cohort
The Lancet Respiratory Medicine, Volume 2, No. 4, Year 2014
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Description
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 38859 patients. Opportunities for diagnosis were missed in 32900 (85%) of 38859 patients in the 5 years immediately preceding diagnosis of COPD; in 12856 (58%) of 22286 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. © 2014 Elsevier Ltd.
Authors & Co-Authors
Jones, Rupert
United Kingdom, Plymouth
Plymouth University, Peninsula Schools of Medicine and Dentistry
Price, David B.
United Kingdom, Aberdeen
University of Aberdeen
United Kingdom, Cambridge
Research in Real Life
Ryan, Dermot P.
United Kingdom, Loughborough
Woodbrook Medical Centre
United Kingdom, Edinburgh
The University of Edinburgh
Sims, Erika J.
United Kingdom, Cambridge
Research in Real Life
United Kingdom, Norwich
University of East Anglia, Norwich Medical School
von Ziegenweidt, Julie
United Kingdom, Cambridge
Research in Real Life
Mascarenhas, Laurence
United Kingdom, Cambridge
Research in Real Life
United Kingdom, Leatherhead
Nhs Surrey
Burden, Anne
United Kingdom, Cambridge
Research in Real Life
Halpin, David M.G.
United Kingdom, Exeter
University of Exeter Medical School
Winter, Robert
United Kingdom, Cambridge
East of England Strategic Health Authority
Hill, Sue
United Kingdom, London
Respiratory Programme
Kearney, Matt
United Kingdom, London
Respiratory Programme
Holton, Kevin
United Kingdom, London
Respiratory Programme
Moger, Anne
United Kingdom, London
Respiratory Programme
Freeman, Daryl
United Kingdom, Mundesley
Mundesley Medical Centre
Chisholm, Alison M.
United Kingdom, Cambridge
Research in Real Life
Bateman, Eric D.
South Africa, Cape Town
Faculty of Health Sciences
Statistics
Citations: 169
Authors: 16
Affiliations: 12
Identifiers
Doi:
10.1016/S2213-2600(14)70008-6
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study