Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

Abstract

BackgroundCOPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting.ObjectivesTo describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap.MethodsCOPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year.ResultsAmong the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients.ConclusionCOPD, asthma, and asthma–COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.

Risk factors of chronic obstructive pulmonary disease exacerbations

“…The relationship between COPD exacerbation and the degree of airflow limitation was demonstrated by several studies …”

“…Montes de Oca et al revealed an increased number of medical visits directly correlated with the airflow obstruction severity and dyspnea, while Foda showed that an increased airway obstruction determined a more severe AECOPD …”

“…The relationship between COPD exacerbation and the degree of airflow limitation was demonstrated by several studies. [63][64][65][66][67] A recent 3-year study published in the Netherlands, which included 795 COPD patients with a lower FEV 1 % predicted was associated with a higher risk of hospital admission for a severe AECOPD with an HR of 2.0 (95% CI 1.4-2.5) for patients treated with tiotropium respectively an HR of 2.04 (95% CI 1.43-2.50) for ICS treated patients. Furthermore, a lower FEV 1 % predicted at baseline was associated with a higher mortality risk.…”

“…64 A study developed in Hong Kong showed that 77% of hospital admissions were for patients with COPD with moderate to severe airflow limitation. 65 Montes de Oca et al revealed an increased number of medical visits directly correlated with the airflow obstruction severity and dyspnea, 66 while Foda showed that an increased airway obstruction determined a more severe AECOPD. 67…”

“…93 Similar results were reported by other studies. 66,92-94 Montes de Oca et al 66 evidenced that the number of exacerbations was 4.9 times higher in patients with ACO, while Kang et al 94 found that these patients suffered more frequent and more severe exacerbations, resulting in a higher number of hospital admissions.…”