Corerelation of COPD exacerbation with comorbidities, Lung function and mortality within a single-practice primary-care cohort in the UK

Abstract

Introduction and Objectives: COPD as being a heterogeneous disease, its patients show variation in disease severity, burden of comorbidity and their need for unscheduled clinical consultations. The aim of this retrospective study was to evaluate patterns in clinical care and COPD related ‘events’ across a single-year in a UK single-practice primary-care cohort. Methods: The clinical record system of practice population of 11474 patients was searched to identify all registered patients with COPD with data available for the period April17–March18. All cases were reviewed including disease duration, account of exacerbations with their treatment, related hospitalizations and mortality, co-morbidities and changes in FEV1. Results: Out of total 331 COPD patients; most had long-standing disease approx 10 years, although this varied widely. Mean % FEV1 was 60.4% (range 14–118%) with 71% with dyspnoea of MRC 2 or 3. 95% of them had at least one co-morbidity, mainly diabetes/arthritis or cardiovascular disease. There was no exacerbation in 137 patients (41.4%). Of patients with at least one event, 111 (33.5%) required treatment with antibiotics + oral steroids and 28 of these patients (8.5%) showed decline in FEV1. 22 patients required emergency COPD-related hospitalisations with 5 in-hospital deaths. The mean FEV1 in those patients without an exacerbation was higher compared to those with an exacerbation (66.6% vs 55.9%) and a further decline was noted in those with hospital admission history (45.8%). Conclusions: A substantial variation was observed in COPD disease burden and healthcare resource usage within the 12 months across a primary-care cohort in UK.