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International Journal of Chronic Obstructive Pulmonary Disease Volume 9, 2014 - Issue
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Original Research

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

David Price1 Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UKCorrespondence[email protected]
,
Daniel West2 Research in Real-Life Ltd, Cambridge, UK
,
Guy Brusselle3 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium;4 Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands;5 Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
,
Kevin Gruffydd-Jones6 Box Surgery, Wiltshire, UK
,
Rupert Jones7 Centre for Clinical Trials and Health Research – Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth UK
,
Marc Miravitlles8 Department of Pneumology, Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
,
Andrea Rossi9 Pulmonary Unit, Cardiovascular and Thoracic Department, University and General Hospital, Verona, Italy
,
Catherine Hutton2 Research in Real-Life Ltd, Cambridge, UK
,
Valerie L Ashton2 Research in Real-Life Ltd, Cambridge, UK
,
Rebecca Stewart2 Research in Real-Life Ltd, Cambridge, UK
&
Katsiaryna Bichel2 Research in Real-Life Ltd, Cambridge, UK
 show all
Pages 889-905 | Published online: 27 Aug 2014

Figures & data

Figure 1 Patient selection.

Note: Data were extracted in May 2013.
Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; OPCRD, Optimum Patient Care Research Database; QOF, quality and outcomes framework.
Figure 1 Patient selection.

Table 1 Patient demographics for the total COPD population split by GOLD group

Table 2 Patient demographics for the GOLD Stage 2 population split by GOLD group

Figure 2 Distribution of GOLD groups in patients without and with moderate and severe exacerbations in the year prior to data extraction for total COPD population (A) and GOLD Stage 2 subset (B).

Note: GOLD groups calculated without COPD Assessment Test score.
Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease.
Figure 2 Distribution of GOLD groups in patients without and with moderate and severe exacerbations in the year prior to data extraction for total COPD population (A) and GOLD Stage 2 subset (B).

Figure 3 Current management for total COPD population (A) and GOLD Stage 2 subset (B) by GOLD groups.

Notes: Percentages were calculated against the total number of patients in the COPD population (n=24,957) and GOLD Stage 2 subset (n=13,557). Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline.
Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β2-agonist.
Figure 3 Current management for total COPD population (A) and GOLD Stage 2 subset (B) by GOLD groups.

Figure 4 Current management by concomitant asthma diagnosis for total COPD population (A) and GOLD Stage 2 subset (B).

Note: Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline.
Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β2-agonist.
Figure 4 Current management by concomitant asthma diagnosis for total COPD population (A) and GOLD Stage 2 subset (B).

Figure 5 Current management by moderate and severe exacerbation rate in the year prior to data extraction for the GOLD Stage 2 subset.

Note: Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline.
Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β2-agonist.
Figure 5 Current management by moderate and severe exacerbation rate in the year prior to data extraction for the GOLD Stage 2 subset.

Figure 6 Current management by mMRC score (A) and CAT score (B) for the GOLD Stage 2 subset.

Notes: mMRC scores are taken from the most recent routine data or questionnaire data to the extraction date. Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline.
Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β2-agonist.
Figure 6 Current management by mMRC score (A) and CAT score (B) for the GOLD Stage 2 subset.

Figure S1 Model of symptom/risk evaluation of COPD.

Notes: When assessing risk, choose the highest risk according to GOLD stage or exacerbation history (one or more hospitalizations for COPD exacerbations should be considered high risk). GOLD 1, 2, 3, and 4 correspond to mild (FEV1 ≥80% predicted), moderate (50% ≤ FEV1 <80% predicted), severe (30% ≤ FEV1 <50% predicted), and very severe (FEV1 <30% predicted) airflow limitation, respectively. Reproduced from the Global Strategy for Diagnosis, Management and Prevention of COPD 2014. Copyright © Global Initiative for Chronic Obstructive Lung Disease (GOLD), all rights reserved. Available from http://www.goldcopd.org.Citation1

Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council.

Figure S1 Model of symptom/risk evaluation of COPD.Notes: When assessing risk, choose the highest risk according to GOLD stage or exacerbation history (one or more hospitalizations for COPD exacerbations should be considered high risk). GOLD 1, 2, 3, and 4 correspond to mild (FEV1 ≥80% predicted), moderate (50% ≤ FEV1 <80% predicted), severe (30% ≤ FEV1 <50% predicted), and very severe (FEV1 <30% predicted) airflow limitation, respectively. Reproduced from the Global Strategy for Diagnosis, Management and Prevention of COPD 2014. Copyright © Global Initiative for Chronic Obstructive Lung Disease (GOLD), all rights reserved. Available from http://www.goldcopd.org.Citation1Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council.

Figure S2 Modified Medical Research Council questionnaire for assessing the severity of breathlessness.

Reproduced from the Global Strategy for Diagnosis, Management and Prevention of COPD 2014. Copyright © Global Initiative for Chronic Obstructive Lung Disease (GOLD), all rights reserved. Available from http://www.goldcopd.org.Citation1

Abbreviation: mMRC, modified Medical Research Council.

Figure S2 Modified Medical Research Council questionnaire for assessing the severity of breathlessness.Reproduced from the Global Strategy for Diagnosis, Management and Prevention of COPD 2014. Copyright © Global Initiative for Chronic Obstructive Lung Disease (GOLD), all rights reserved. Available from http://www.goldcopd.org.Citation1Abbreviation: mMRC, modified Medical Research Council.

Figure S3 COPD Assessment Test.

Notes: The COPD Assessment Test score is calculated as the sum of the responses present. If more than two responses are missing, a score cannot be calculated; when one or two items are missing their scores can be set to the average of the nonmissing item scores. Reproduced with permission. COPD Assessment Test and CAT logo is a trade mark of the GlaxoSmithKline group of companies. © 2009 GlaxoSmithKline group of companies. All rights reserved.Citation2

Figure S3 COPD Assessment Test.Notes: The COPD Assessment Test score is calculated as the sum of the responses present. If more than two responses are missing, a score cannot be calculated; when one or two items are missing their scores can be set to the average of the nonmissing item scores. Reproduced with permission. COPD Assessment Test and CAT logo is a trade mark of the GlaxoSmithKline group of companies. © 2009 GlaxoSmithKline group of companies. All rights reserved.Citation2

Table S1 Characteristics of patients with COPD who were responders or nonresponders to the study questionnaires

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