Chronic obstructive pulmonary disease in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

Abstract

CMAJ OPEN, 3(1) E15Research CMAJ OPEN C hronic obstructive pulmonary disease (COPD) is a substantial source of morbidity and mortality in Canada and globally. Estimates place the worldwide prevalence at 9%-10% from physiologic-based studies and 3%-8% from studies based on physician-or patient-reported diagnosis or symptoms.1,2 Globally, COPD is rated as the fifth leading cause of death, and ninth in contributions to loss of disability-adjusted life years.3,4 A recent systematic review of COPD epidemiology worldwide identified 12 Canadian studies, which produced prevalence estimates that ranged from 3% to 12%, depending on the method used.5 Canadian data from a study using spirometry to screen a populationbased sample suggest a rate of about 10%. 6 There are limited data on COPD either alone or in combination with other chronic diseases from primary care settings.In other countries, the limited reports on COPD prevalence in primary care settings show marked variation depending on the method of identification of illness. A study from the United Kingdom based on electronic records in the Computerized Patient Records Database found the prevalence of physician-diagnosed COPD to be less than 1% for women and only 1.35% for men.7 Another practice-based research network study from the UK that invited participants in a postal survey to come for spirometry if they had either symptoms or a smoking history found a much higher prevalence (4.1% overall, 9.6% in patients over 40 yr).8 A recent Spanish study using data from electronic medical records (EMRs) found a physician-diagnosed prevalence of 3.2%, 90% of whom were also found to have at least 1 comorbid condition. Background: Chronic obstructive pulmonary disease (COPD) is mostly managed within primary care, but there is little Canadian evidence from this setting. This study was undertaken to determine the prevalence of physician-diagnosed COPD in primary care practices, and the degree of comorbidity with other chronic conditions, and to assess patterns of medication prescribing.

An evaluation of early medication use for COPD: a population-based cohort study

“…Consistent with current literature, the use of SABD accounted for a significant proportion of medications used in our cohort of new medication users 1,17,24. This is expected considering the reasonable relative effectiveness of these classes of medications and their place as first-line therapies in previous and current COPD practice guidelines 22,23.…”

“…The presence of multiple comorbidities is common among COPD patients, with the vast majority of patients using multiple classes of chronic non-COPD medications 1–3. In addition to significant effects on morbidity, COPD is the third leading cause of death in the world 4.…”

Chronic obstructive pulmonary disease and comorbidities: a large cross-sectional study in primary care

“…This study's COPD prevalence of 4.1% was similar to the 3.4% found by a Canadian study 22 but higher than 1.4% in a study from England. 23 Within the group of people with COPD, 86.0% had ≥1 comorbidities, slightly higher than the prevalence range of 76-82% found in three recent studies.…”

“…23 Within the group of people with COPD, 86.0% had ≥1 comorbidities, slightly higher than the prevalence range of 76-82% found in three recent studies. 5,22,24 The types of comorbidities included in different studies varied significantly, which is likely to account, at least in part, for these differences.…”

Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network

“…At that time, the network included data from 444 sentinel physicians and nurse practitioners providing data on more than 440 000 patients from their practices in 7 provinces across Canada. Data from this period have been used consistently in a series of studies describing the prevalence and management of the 8 CPCSSN "index conditions" in primary care, [12][13][14][15][16] of which this study is the latest.…”