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

Abstract

Background

COPD, 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.

Objectives

To 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.

Methods

COPD 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.

Results

Among 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.

Conclusion

COPD, 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.

Keywords:

• COPD
• asthma
• asthma-COPD overlap
• exacerbation
• health care resource utilization
• primary care
• PUMA

Acknowledgments

Editorial support was provided by Ian Wright, of Wright Medical Communications Ltd, and funded by AstraZeneca.

Author contributions

MMO is the guarantor of the content of the manuscript, including the data and analysis. All authors contributed to the study concept, design, acquisition of data, analysis, and interpretation of data. MMO took the lead role in writing the manuscript, while all authors provided critical revision of the manuscript and read and approved the final version.

Disclosure

This observational study was funded by AstraZeneca Latin America. AstraZeneca had no input into the study design, analysis and interpretation of the results.

FS is in full-time employment with AstraZeneca Latin America. The other authors report no conflicts of interest in this work.