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COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction

COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction
COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction
Chronic obstructive pulmonary disease (COPD) is heterogeneous, but persistent airflow obstruction (AFO) is fundamental to diagnosis. We studied AFO consistency from initial diagnosis and explored factors associated with absent or inconsistent AFO. This was a retrospective observational study using patient-anonymised routine individual data in Care and Health Information Analytics (CHIA) database. Identifying a prevalent COPD cohort based on diagnostic codes in primary care records, we used serial ratios of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC%) from time of initial COPD diagnosis to assign patients to one of three AFO categories, according to whether all (persistent), some (variable) or none (absent) were <70%. We described respiratory prescriptions over 3 years (2011–2013) and used multivariable logistic regression to estimate odds of absent or variable AFO and potential predictors. We identified 14,378 patients with diagnosed COPD (mean ± SD age 68.8 ± 10.7 years), median (IQR) COPD duration of 60 (25,103) months. FEV1/FVC% was recorded in 12,491 (86.9%) patients: median (IQR) 5 (3, 7) measurements. Six thousand five hundred and fifty (52.4%) had persistent AFO, 4507 (36.1%) variable AFO and 1434 (11.5%) absent AFO. Being female, never smoking, having higher BMI or more comorbidities significantly predicted absent and variable AFO. Despite absent AFO, 57% received long-acting bronchodilators and 60% inhaled corticosteroids (50% and 49%, respectively, in those without asthma). In all, 13.1% of patients diagnosed with COPD had unrecorded FEV1/FVC%; 11.5% had absent AFO on repeated measurements, yet many received inhalers likely to be ineffective. Such prescribing is not evidence based and the true cause of symptoms may have been missed.
2055-1010
1-9
Josephs, Lynn
865f1878-f0ca-42c3-a030-df6dcbc705b0
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Johnson, Matthew James
d272ca76-f017-4457-96f5-daf6a7af6adf
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Josephs, Lynn
865f1878-f0ca-42c3-a030-df6dcbc705b0
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Johnson, Matthew James
d272ca76-f017-4457-96f5-daf6a7af6adf
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953

Josephs, Lynn, Culliford, David, Johnson, Matthew James and Thomas, Mike (2019) COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction. NPJ primary care respiratory medicine, 29 (1), 1-9, [33]. (doi:10.1038/s41533-019-0145-7).

Record type: Article

Abstract

Chronic obstructive pulmonary disease (COPD) is heterogeneous, but persistent airflow obstruction (AFO) is fundamental to diagnosis. We studied AFO consistency from initial diagnosis and explored factors associated with absent or inconsistent AFO. This was a retrospective observational study using patient-anonymised routine individual data in Care and Health Information Analytics (CHIA) database. Identifying a prevalent COPD cohort based on diagnostic codes in primary care records, we used serial ratios of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC%) from time of initial COPD diagnosis to assign patients to one of three AFO categories, according to whether all (persistent), some (variable) or none (absent) were <70%. We described respiratory prescriptions over 3 years (2011–2013) and used multivariable logistic regression to estimate odds of absent or variable AFO and potential predictors. We identified 14,378 patients with diagnosed COPD (mean ± SD age 68.8 ± 10.7 years), median (IQR) COPD duration of 60 (25,103) months. FEV1/FVC% was recorded in 12,491 (86.9%) patients: median (IQR) 5 (3, 7) measurements. Six thousand five hundred and fifty (52.4%) had persistent AFO, 4507 (36.1%) variable AFO and 1434 (11.5%) absent AFO. Being female, never smoking, having higher BMI or more comorbidities significantly predicted absent and variable AFO. Despite absent AFO, 57% received long-acting bronchodilators and 60% inhaled corticosteroids (50% and 49%, respectively, in those without asthma). In all, 13.1% of patients diagnosed with COPD had unrecorded FEV1/FVC%; 11.5% had absent AFO on repeated measurements, yet many received inhalers likely to be ineffective. Such prescribing is not evidence based and the true cause of symptoms may have been missed.

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More information

Accepted/In Press date: 10 July 2019
e-pub ahead of print date: 15 August 2019
Published date: 15 August 2019

Identifiers

Local EPrints ID: 433693
URI: http://eprints.soton.ac.uk/id/eprint/433693
ISSN: 2055-1010
PURE UUID: 88812716-dbbe-4032-ac42-6937bbe4ea07
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253

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Date deposited: 30 Aug 2019 16:30
Last modified: 26 Nov 2021 02:48

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Contributors

Author: Lynn Josephs
Author: David Culliford ORCID iD
Author: Matthew James Johnson
Author: Mike Thomas

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