Abstract
BackgroundIt has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing.AimTo investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting.Design and SettingA cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included.MethodsParticipants were contacted for follow-up at one- and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD.ResultsA total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08–0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables.ConclusionCOPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, accounting for an estimated 81.6 million disability adjusted life-years and 3.2 million deaths in 2019.1,2 It is the third leading cause of death in the UK and a major cause of emergency hospital admission, with an estimated annual cost to the NHS of £1.9 billion.[3,4] Patients with COPD are prone to acute exacerbations where there is rapid and sustained worsening of symptoms beyond normal day-to-day variation
All models adjusted for time point (1-week, 2-weeks, and 4-weeks), Clinical COPD Questionnaire (CCQ) total score, antibiotic prescribing, and OCS prescribing at the index consultation, and allocation to usual care or CRPPOCT
We described health status in a cohort of patients presenting to primary care with an Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) and investigated variables associated with CQC total scores
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, accounting for an estimated 81.6 million disability adjusted life-years and 3.2 million deaths in 2019.1,2 It is the third leading cause of death in the UK and a major cause of emergency hospital admission, with an estimated annual cost to the NHS of £1.9 billion.[3,4] Patients with COPD are prone to acute exacerbations where there is rapid and sustained worsening of symptoms beyond normal day-to-day variation. Aim: To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08– 0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion: COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
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