COPD In Primary Care Research Articles

Improving Clinical Diagnosis of COPD in Primary Care: Results of a Cluster-Randomized Controlled Study Utilizing a Screening Questionnaire With or Without a Handheld Spirometric Device Compared With Usual Care

Improving Clinical Diagnosis of COPD in Primary Care: Results of a Cluster-Randomized Controlled Study Utilizing a Screening Questionnaire With or Without a Handheld Spirometric Device Compared With Usual Care

Corrigendum

Corrigendum Siebeling L, Puhan MA, Muggensturm P, Zoller M, ter Riet G. Characteristics of Dutch and Swiss primary care COPD patients – baseline data of the ICE COLD ERIC study. Clin Epidemiol. 2011;3:273–283.Due to two duplicate records, the correct number of patients in the Ice Cold Eric study is 409, not 411. The reported results did not materially change. Those who wish to see the updated tables may contact the corresponding author.Read the original article

Twenty-five Statements on Early Initiation of Fixed Combination ICS/LABA Treatment for Asthma and COPD in Primary and Secondary Care: Consensus Research by a Modified Delphi Process

Guidelines recommend the addition of a long-acting β2-agonist (LABA) for patients whose asthma is uncontrolled on inhaled corticosteroid (ICS) monotherapy. For COPD patients the addition of an ICS to a long-acting bronchodilator is recommended for symptomatic patients at high risk of exacerbations. We examined whether in real-life practice guideline recommendations may delay optimal timing for initiation of combination treatment. A modified Delphi process was undertaken with a panel of physicians, including six GPs and four pulmonologists, in practice in Germany. The first round comprised a semi-structured questionnaire, the second stage was an online discussion to reach consensus on 25 statements concerning the use of ICS/LABA in patients with asthma or COPD. Consensus was achieved on 24 of 25 prepared statements for early initiation of fixed ICS/LABA combination treatment. The panel agreed that a meaningful share of their asthma patients on ICS monotherapy experienced symptoms and exacerbations that should lead to addition of LABAs and that timely initiation of ICS/LABA therapy in asthma patients could improve asthma control, and prevent a significant number of emergency room visits, hospitalisations or additional specialist visits. The panel agreed that symptomatic patients with moderate to severe COPD, and frequent exacerbations should receive ICS without any delay in addition to their bronchodilator maintenance therapy. These patients could benefit from fewer exacerbations and a reduction in symptoms. The panel reached a consensus that fixed-dose ICS/LABA could have a positive effect on adherence, compared with separate inhalers for ICS and LABA, which may impact treatment outcomes. A panel of ten physicians working in primary and secondary care agreed on 24 out of 25 statements that supported the early initiation of fixed combination treatment, if indicated in a meaningful number of their asthma and COPD patients.

Case finding for COPD in primary care: a systematic review

Case finding for COPD in primary care: a systematic review

COPD in primary care

As GPs working for the London Respiratory Team, we were extremely pleased to see the high profile given to COPD in February's BJGP 1–4 since we believe that primary care, as part of an integrated pathway, has a major role both in earlier diagnosis and continued management of this condition. We would like to highlight two concepts from our workstreams:5 first that COPD is as …

COPD in primary care

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

P219 Ten year mortality in a primary care COPD cohort: multidimensional index BOD more discriminant than GOLD staging

Of potential prognostic variables for COPD to use in a multidimensional staging tool, BMI, severity of airflow obstruction (FEV1% predicted) and the MRC Dyspnoea Score (BOD) have been shown to...

Depression and Heart Failure Affect Clinical COPD Questionnaire Outcome in Primary Care COPD Patient

Depression and Heart Failure Affect Clinical COPD Questionnaire Outcome in Primary Care COPD Patient

Functional status measurement in COPD: a review of available methods and their feasibility in primary care

Guidelines advocate that improvement in functional status should be a major goal in COPD treatment. Many tools are available to assess aspects of functional status. This review aims to categorize systematically the available tools based on their construct (i.e. what the tool intends to measure) and to rate the tools for use in the primary care setting. PubMed was searched with the keywords 'functional status' or 'physical capacity' or 'functional capacity' and 'COPD'. All tools were categorised and rated on their measurement properties, feasibility, and usage in primary care COPD patients. The tools were divided into four constructs - functional capacity, functional performance, functional reserve, and capacity utilisation - and used the following modes of measurement: laboratory tests; semi-laboratory tests; field tests; and patient-reported outcomes. The PubMed search resulted in 364 articles. Thirty-two tools were identified and rated. In primary care, the 6-minute walking distance test is the most reliable semi-laboratory functional capacity test, but is not very practical. The pedometer is the best functional performance field test. The Medical Research Council (MRC) dyspnoea questionnaire and the functional status domain of the Clinical COPD Questionnaire (CCQ) are the best patient-reported outcome tools to assess functional performance.

Diagnosis and management of patients with COPD in primary care

This article discusses the diagnosis and management of chronic obstructive pulmonary disease in primary care, in the light of recent updates to national guidelines. It describes the use of spirometry, differential diagnosis, treatment options such as pharmacological management, oxygen therapy, pulmonary rehabilitation and the management of exacerbations.

Diagnosis and management of patients with COPD in primary care

Diagnosis and management of patients with COPD in primary care

Early detection of COPD in primary care--the Copenhagen COPD Screening Project.

BackgroundChronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death in the world, and further increases in the prevalence and mortality are predicted. Delay in diagnosing COPD appears frequently even though current consensus guidelines emphasize the importance of early detection of the disease. The aim of the present study is to evaluate the effectiveness of a screening programme in general practice.Methods/DesignSubjects aged 65 years and older registered with a General Practitioner (GP) in the eastern Copenhagen will receive a written invitation and a simple questionnaire focusing on risk factors and symptoms of COPD. Subjects who meet the following criteria will be encouraged to undergo spirometric testing at their GP: current smokers, former smokers, and subjects with no smoking history but who have dyspnea and/or chronic cough with sputum.DiscussionThe Copenhagen COPD Screening Project evaluates the effectiveness of a two-stage screening program for COPD in general practice and provides important information on how to organize early detection of COPD in general practice in the future.

Low body mass index, airflow obstruction, and dyspnoea in a primary care COPD patient population

The objective of our study was to explore the existence/co-existence of factors - as per American Thoracic Society (ATS)/European Respiratory Society (ERS) standards - for staging patients in a primary care COPD population. A representative sample of COPD patients in primary care was studied. Cross-sectional information on airflow obstruction, body mass index (BMI), and dyspnoea (Modified Medical Research Council [MMRC] score) were collected. The existence/co-existence of these prognostic factors is described. The study sample consisted of 2,023 patients. BMI was low in 11.7%, MMRC score > or =2 was found in 28.7%, and 53.9% fulfilled the criteria of relevant airflow obstruction. Only 3.4% of this population scored on all three prognostic factors. Moderate dyspnoea and moderate airflow obstruction were rather prevalent in this primary care population, but coexistence of factors was low. Therefore, it seems that the assessment of BMI and dyspnoea represent additional information on primary care COPD patients.

Adherence to diagnostic guidelines and quality indicators in asthma and COPD in Swedish primary care

To study the clinical evaluation and treatment of patients with asthma and COPD in primary care in Sweden, with a focus on adherence to recommended guidelines and quality indicators. All visits at health care centres in Skaraborg, Sweden, are documented in computerized medical records constituting the Skaraborg Primary Care Database (SPCD). In a register-based retrospective observational study, all patients diagnosed with asthma or COPD during 2000-2005 (n = 12,328) were identified. In a 5% random sample (n = 623), information on performed investigations at initial visits and at follow-up during 2004-2005 was collected. Compliance with procedures as recommended by national guidelines was used for quality assessment. Among 499 patients with asthma, 167 (33%) were investigated with spirometry or Peak Expiratory Flow (PEF) during initial visits in agreement with guidelines. Correspondingly, 40 out of 124 patients with COPD (32%) were investigated with spirometry. During follow-up, evaluation in agreement with guidelines was performed in 130 (60%) of patients with asthma and in 35 patients out of 77 (45%) with COPD. Prescribing of ICS reached quality target, still every second patient made an acute visit during follow-up. Adherence to recommended guidelines in asthma/COPD was low. Acute visits were common and despite the prescribing of ICS according to recommendations, patients still seem uncontrolled in their disease. There is a need for quality improvement in the clinical evaluation and treatment of patients with asthma and COPD.

Relationship Between Gastroesophageal Reflux Disease and COPD in UK Primary Care

Gastroesophageal reflux symptoms may be more common in patients with COPD than in control subjects. The aim of this study was to investigate the relationship between diagnoses of COPD and gastroesophageal reflux disease (GERD) in primary care. We used the UK General Practice Research Database to identify a cohort of patients with a first diagnosis of GERD (n = 4,391) and another cohort of patients with a first diagnosis of COPD (n = 1,628) during 1996, which we compared with age-matched and sex-matched comparison cohorts without either diagnosis. We calculated the incidence of a GERD diagnosis among the patients with COPD and control subjects, and of a COPD diagnosis among the patients with GERD and control subjects. We also calculated the relative risk (RR) estimates of these diagnoses using the Mantel-Haenszel test. Risks associated with medication use, comorbidities, and demographic and lifestyle factors were examined using a nested case-control analysis. During the 5-year follow-up, the RR of an incident COPD diagnosis in patients with a diagnosis of GERD was 1.17 (95% confidence interval [CI], 0.91 to 1.49), while the RR of an incident GERD diagnosis among patients with a diagnosis of COPD was 1.46 (95% CI, 1.19 to 1.78). A COPD diagnosis was associated with current or former smoking, prior diagnosis of asthma, or the use of asthma medication. A GERD diagnosis was associated with a prior diagnosis of ischemic heart disease. Patients with a diagnosis of COPD are at a significantly increased risk of a diagnosis of GERD compared with individuals with no COPD diagnosis.

Prevalence of COPD in primary care: no room for complacency

Prevalence of COPD in primary care: no room for complacency

Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit.

BackgroundGuidelines on COPD diagnosis and management encourage primary care physicians to detect the disease at an early stage and to treat patients according to their condition and needs. Problems in guideline implementation include difficulties in diagnosis, using spirometry and the disputed role of reversibility testing. These lead to inaccurate diagnostic registers and inadequacy of administered treatments. This study represents an audit of COPD diagnosis and management in primary care practices in Devon.MethodsSix hundred and thirty two patients on COPD registers in primary care practices were seen by a visiting Respiratory Specialist Nurse. Diagnoses were made according to the NICE guidelines. Reversibility testing was carried out either routinely or based on clinical indication in two sub-samples. Dyspnoea was assessed. Data were entered into a novel IT-based software which computed guideline-based treatment recommendations. Current and recommended treatments were compared.ResultsFive hundred and eighty patients had spirometry. Diagnoses of COPD were confirmed in 422 patients (73%). Thirty nine patients were identified as asthma only, 94 had normal spirometry, 23 were restrictive and 2 had a cardiac disorder. Reversibility testing changed diagnosis of 11% of patients with airflow obstruction, and severity grading in 18%. Three quarters of patients with COPD had been offered practical help with smoking cessation. Short and long-acting anticholinergics and long acting beta-2 agonists had been under-prescribed; in 15–18% of patients they were indicated but not received. Inhaled steroids had been over-prescribed (recommended in 17%; taken by 60%), whereas only 4% of patients with a chronic productive cough were receiving mucolytics. Pulmonary rehabilitation was not available in some areas and was under-used in other areas.ConclusionDiagnostic registers of COPD in primary care contain mistakes leading to inaccurate prevalence estimates and inappropriate treatment decisions. Use of pre-bronchodilator readings for diagnosis overestimates the prevalence and severity in a significant minority, thus post bronchodilator readings should be used. Management of stable COPD does often not correspond to guidelines. The IT system used in this study has the potential to improve diagnosis and management of COPD in primary care.

Asthma and COPD in primary health care, quality according to national guidelines: a cross-sectional and a retrospective study.

BackgroundIn recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results.MethodsA cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Östergötland, Sweden, were included.ResultsAll centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration.ConclusionTo provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP.

Management of COPD: pulmonologists' adherence to Polish guidelines

Literature data suggest that management of COPD in primary care and by specialists differ from national or international guidelines. Aim of this investigation was to evaluate routine management of COPD by Polish pulmonologists and to compare it to COPD guidelines of the Polish Society of Lung Diseases published in 1997 and updated in 2004. Questionnaire containing 33 questions was distributed to 800 participants of a national congress of the Society. Response rate was 10%. Term COPD is used by 95% of responders (R). For 73% of R COPD patients count for more than 20% of their consultations. Clinical signs of cor pulmonale are present in 10% and signs of respiratory failure in 10 to 20% of all patients. Patients with mild, moderate, severe and very severe disease represent respectively 18, 48, 24 and 10% of the total. Spirometry is performed to confirm diagnosis by 81% of R. However, bronchodilating test is performed in all patients only by 34% of R. 97% of R give antismoking advice to all patients. Only 6% of R are current smokers and 61% are life nonsmokers. Bronchodilating treatment is commonly prescribed. Most frequently prescribed drugs are: LABA (65% of patients) short acting anticholinergic (44%) and ICS (21%) of patients. ICS are over prescribed and systemic steroids are still chronically used in somewhat less than 20% of patients. 43% of R give systemic steroids to all patients during exacerbation of severe disease. Results of the study should be taken with caution. Low response rate suggest that only physicians interested in the treatment of COPD patients participated. A real life situation is probably worse than presented. Pneumonol. Alergol. Pol. 2005, 73, 135-141 .

The impact of the 2004 NICE guideline and 2003 General Medical Services contract on COPD in primary care in the UK

The introduction of the NICE guideline on COPD and the inclusion of COPD in the new Quality and Outcomes Framework (QOF) were designed to improve the care of people with COPD in primary care in the UK. We have investigated whether these initiatives have had an impact on the prevalence of COPD, the recording of spirometry data and the use of combined inhaled corticosteroid/long-acting beta-agonist inhalers. We analysed data from The Health Improvement Network for the year before and after the introduction of the NICE guideline. Data were analysed using logistic regression. The prevalence of COPD in 2003 was 1.27%, and this increased by 14-1.45% in 2005. The risk of COPD was strongly related to age, male gender, socioeconomic disadvantage and living in the North of England, Scotland and Wales. People with COPD had an increased mortality (adjusted rate ratio for 2003 is 2.38, 95% confidence interval 2.30-2.47). The presence of recorded spirometry data in people with COPD increased from 18% in 2003 to 62% in 2005, and FEV1 was consistently a strong predictor of survival. The use of combination inhalers in people with moderate to severe COPD also increased markedly during the study. Following the introduction of the NICE guideline for COPD and the new QOF, there has been an increase in the prevalence of COPD in general practice and a large increase in spirometry data and prescriptions for combination inhalers. This represents significant progress for people with COPD.