Epidemiology, severity, and treatment of chronic obstructive pulmonary disease in the United Kingdom by GOLD 2013

Abstract

ObjectivesIn 2013, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated the management strategy on COPD based on severity using a combined assessment of symptoms, degree of airflow limitation, and number of exacerbations. This study quantified prevalence and incidence of COPD in the United Kingdom and estimated disease severity by GOLD 2013 categories A/B (low risk) and C/D (high risk).MethodsThe Clinical Practice Research Datalink was used to identify COPD patients ≥40 years. Patient characteristics were described, and prevalence was calculated on December 31, 2013. Five-year incidence (2009–2013) was estimated, with rates standardized using 2011 UK population age and sex. To classify patients by GOLD categories, spirometry results, the modified British Medical Research Council grade, and history of exacerbations were used.ResultsThe prevalent cohort comprised 49,286 patients with COPD with mean age 70 years; 51.0% were male. Overall prevalence was 33.3 per 1,000 persons (95% confidence interval [CI]: 33.1–33.6); 66.4% were classified as GOLD A/B and 33.6% as C/D. The standardized prevalence of GOLD A/B was 21.9 per 1,000 persons (95% CI: 21.7–22.1) and of C/D was 11.1 (95% CI: 10.9–11.2). A total of 27,224 newly diagnosed COPD patients were identified with mean age 67 years at diagnosis; 53.0% were male. Incidence was 2.2 per 1,000 person-years (95% CI: 2.2–2.3); 68.7% were classified in categories A/B and 31.3% in C/D, of which 17.2% did not receive COPD maintenance medication.ConclusionA third of COPD patients in the UK are considered high risk (GOLD 2013 categories C/D), and a third of patients are diagnosed for the first time at these severe stages. Given the progressive nature of the disease, results suggest that closer attention to respiratory symptoms for early detection, diagnosis, and appropriate treatment of COPD in the UK is warranted.

Patterns of use of long‐acting bronchodilators in patients with COPD: A nationwide follow‐up study of new users in New Zealand

“…The overall finding of this study-that the prescribing of long-acting bronchodilators and ICSs in patients with COPD does not appear to align with GOLD guidelines 2-15 -is consistent with recent studies based on subgroups of patients in a variety of settings. Our observation that the most commonly dispensed first regimen involving a long-acting bronchodilator was a LABA in combination with an ICS is consistent with findings from Spain, 14 the Netherlands 33 and some, 8,11,13,34,35 but not all, 15 studies based in the UK. In several studies, researchers have had access to detailed clinical information which enabled them to assess the appropriateness of ICS use and subsequently conclude that ICS therapy was being overused.…”

“…Recent studies in diverse settings have found that prescribing practice does not conform to international or national COPD treatment guidelines, or drug licencing conditions. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, these investigations have been based on subgroups of patients drawn from selected general practices, health insurance databases, or respiratory outpatient clinics or hospitals, and none have examined the longitudinal patterns of use of long-acting bronchodilator therapy in new users across an entire country.…”

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

“…23,24 Our finding that newly identified cases tended to have mild or moderate airflow obstruction was in keeping with previous case-finding studies 10 and newly case-found patients were generally less severe than patients newly diagnosed in primary care. 25 Nevertheless, in accordance with our model, the majority of new cases could potentially benefit from inhalers, 26,27 self-management support, 28 smoking cessation 29 and vaccinations. 30 A substantial proportion (27%) also had significant breathlessness with potential to benefit from pulmonary rehabilitation.…”

Recording of hospitalizations for acute exacerbations of COPD in UK electronic health care records

“…One solution to this problem is to use primary care data, such as CPRD, linked to secondary care data, such as HES. When studying hospitalized AECOPD, for practical reasons, this is not always done,14–16 and others have called for the recording hospitalizations for AECOPD in UK primary care data to be validated using HES as a reference standard 17…”