Åsa Athlin

Diagnostics, grading and care organization of patients with chronic obstructive pulmonary disease (COPD)

Guidelines for the treatment of COPD are regularly being updated within the country and internationally. Therefore, it is of great interest to investigate how these recommendations are being followed in practice and to evaluate how patients benefit from them.

Background

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in Sweden with a prevalence of approximately 10 % in the adult population. It is a major cause of morbidity. Globally COPD is estimated to be the third most prevalent cause of death. For diagnosis, spirometry should be performed. Grading of the disease is recommended in order to optimize treatment. Current guidelines from the Global initiative for chronic Obstructive Lung Disease (GOLD), grade COPD based on lung function and exacerbations/health status. There are sparse data on how this classification predicts mortality compared to previous methods of disease classification.

The importance of a correct and early diagnosis is emphasized in all guidelines. Today, COPD can be both under- and overdiagnosed. Previous studies have reported up to 70% of patients diagnosed with COPD without having performed a spirometry. It is of great interest to see if the rate of correct diagnostics has improved. A clinical feature is patients having recorded diagnosis of both asthma and COPD.  Most likely they only have one of them. Little is known about what characterizes this group of patients. The Swedish board of health and welfare strongly recommend nurse-led clinics for patients with COPD. This has showed to decrease the number of exacerbations. It is not clear what components in the structured nurse-led clinic that have the greatest impact

Aim
The overall aim is to evaluate how accurate diagnostics are and if a change over time occurs. Furthermore to compare the prognostic ability of different COPD classifications and to find out which components in clinical care organization that best prevent exacerbations.

Method

This is an observational cohort study where the population is collected from the two COPD cohorts within the PRAXIS study, PRAXIS I and II.

The PRAXIS study was created in 2005 in a region of seven counties in Sweden. It consists of data from reviewing medical journals, patient questionnaires and organizational information from care givers at 14 hospitals and 56 primary health care centers (PHCC). In 2014 a new cohort was created at the same care centers apart from two primary care units. Power analysis estimated a need for 15 patients from each PHCC and 25 from each hospital clinic to gain 80% power.

At each care unit, patients aged 18-74 years with a doctors diagnosis of COPD (ICD-code J44) during a specified period of time, were randomly selected. For PRAXIS I this was between 2000 and 2003. For PRAXIS II from 2007-2010. A self-completion questionnaire together with study information, and a letter of consent was sent to the selected patients. In total, 1089 (PRAXIS I) and 1329 (PRAXIS II) patients were included.

Relevance

This is an observational cohort study where the population is collected from the two COPD cohorts within the PRAXIS study, PRAXIS I and II.

The PRAXIS study was created in 2005 in a region of seven counties in Sweden. It consists of data from reviewing medical journals, patient questionnaires and organizational information from care givers at 14 hospitals and 56 primary health care centers (PHCC). In 2014 a new cohort was created at the same care centers apart from two primary care units. Power analysis estimated a need for 15 patients from each PHCC and 25 from each hospital clinic to gain 80% power.

At each care unit, patients aged 18-74 years with a doctors diagnosis of COPD (ICD-code J44) during a specified period of time, were randomly selected. For PRAXIS I this was between 2000 and 2003. For PRAXIS II from 2007-2010. A self-completion questionnaire together with study information, and a letter of consent was sent to the selected patients. In total, 1089 (PRAXIS I) and 1329 (PRAXIS II) patients were included.

School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden
Huvudhandledare: Josefin Sundh, senior consultant, associate professor Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden