Characterization of secondary care for COPD in Sweden

Josefin Sundh,Christer Janson,Gunnar Johansson,Anders Lindén,Claes-Göran Löfdahl,Thomas Sandström,Kjell Larsson

doi:10.1080/20018525.2016.1270079

Abstract

ABSTRACT Introduction: Only a selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. The aim of this study was to characterize disease severity, treatment and structure of secondary care for COPD in Sweden. Methods: Information was collected from 29 of 33 existing secondary care units of respiratory medicine in Sweden, using both individual data from 373 consecutively enrolled COPD patients with Global initiative on Obstructive Lung Disease (GOLD) stage III–IV and a structural questionnaire about available resources at the units. Patient data included exacerbations, health status assessed by COPD Assessment Test (CAT), lung function, comorbid conditions, pharmacological treatment and vaccinations. Structural data included available smoking cessation support, multidisciplinary rehabilitation, physical training, patient education and routine follow-up after exacerbations at the respective unit. All patients were reclassified according to the GOLD 2014 group A–D classification. Multiple linear regression investigated associations of available resources with number of exacerbations and CAT score. Results: According to GOLD 2014, 87% of the population were GOLD D and 13% were GOLD C. Triple inhaled therapy were prescribed in 88% of the patients. Over 75% of the units had resources for smoking cessation, multidisciplinary rehabilitation, physical training and patient education. Routine follow-up after exacerbations was available in 35% of the units. Being managed at units with access to structured patient education was associated with statistically significantly fewer exacerbations (adjusted regression coefficient (95% confidence interval) −0.79 (−1.39 to −0.19), p = 0.010). Conclusion: Most stage III–IV COPD patients managed at secondary care respiratory units in Sweden have maximized inhaled therapy and high risk disease even when reclassified according to GOLD 2014. Most units have access to smoking cessation, rehabilitation and patient education. Patients managed at units with structured patient education have a lower exacerbation risk.

Highlights

A selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care
Swedish national recommendations of treatment were based on the spirometric classification stage I to IV from Global initiative on Obstructive Lung Disease (GOLD) 2011, but since 2015 the updated guidelines of the National Board of Health and Welfare [6] and the Medical Product Agency [7] recommend a treatment schedule based on the recent GOLD COPD risk evaluation groups A–D, including lung function, symptoms and exacerbation frequency.[8]
As only patients with COPD stage III–IV were included, 100% of the patients fulfilled the spirometric criterion for a high risk according to the present GOLD classification and were classified as either group C or D

Summary

Introduction

A selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. Conclusion: Most stage III–IV COPD patients managed at secondary care respiratory units in Sweden have maximized inhaled therapy and high risk disease even when reclassified according to GOLD 2014. Swedish national recommendations of treatment were based on the spirometric classification stage I to IV from Global initiative on Obstructive Lung Disease (GOLD) 2011, but since 2015 the updated guidelines of the National Board of Health and Welfare [6] and the Medical Product Agency [7] recommend a treatment schedule based on the recent GOLD COPD risk evaluation groups A–D, including lung function, symptoms and exacerbation frequency.[8] It is of utter importance that COPD care can offer support for smoking cessation, multidisciplinary rehabilitation including physical training, structured patient education and follow-up, in particular after exacerbations.[6,7,8]

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Conclusion