Characteristics of COPD Patients Prescribed ICS Managed in General Practice vs. Secondary Care

Figures & data

Figure 1. Flowchart of the selection process in the study. GOLD: Global Initiative for Chronic Obstructive Lung Disease; GP: general practitioner.

Table 1. Characteristics of enrolled patients (n = 2,279) with chronic obstructive pulmonary disease (COPD) and currently prescribed inhaled corticosteroids (ICS) according to whether patients were managed in secondary care by a respiratory specialist or only in primary care by a general practitioner (GP).

	Managed only in primary care (n = 1719)	Also managed in an outpatient clinic in secondary care (n = 560)	P-value
Sex			0.225
Female (n)	938	322
Male (n)	781	238
Age (years)	71.3 (SD 10.94)	70.0 (SD 10.36)	0.013
BMI (kg/m^2)	27.15 (SD 6.23)	26.48 (SD 6.55)	0.071
Pack-years ^a	32.1 (SD 21.82)	35.7 (SD 23.45)	0.033
FEV1 (L)	1.59 (SD 0.65)	1.27 (SD 0.64)	<0.001
FEV1%predicted (%)	63.5 (SD 23.11)	50.1 (SD 21.51)	<0.001
FEV1/FVC	0.59 (SD 0.14)	0.52 (SD 0.15)	<0.001
Blood-eosinophils (10^9/L)	0.25 (SD 0.21)	0.25 (SD 0.21)	0.953
Time since diagnosis (%)			<0.001
≤4 years	19.6	4.8
5–10 years	29.9	8.3
>10 years	20.2	9.9
Diagnoses verified by spirometry (%)	51.7	17.1	<0.001
Annual control visits, ^b (%)	40.3	9.5	<0.001
No annual control visits, ^b (%)
	34.8	14.9

Notes: Mean values unless otherwise stated.

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; MRC, Medical Research Council.

a Pack-years include current smokers and ex-smokers.

b During the preceding year.

Bold text indicates statistical significance with a p-value less than 0.05.

Figure 2. Airflow limitation and severity classification according to GOLD grade. GOLD: Global Initiative for Chronic Obstructive Lung Disease; GP: general practitioner.

Figure 3. GOLD group classification based on symptoms and exacerbation. GOLD: Global Initiative for Chronic Obstructive Lung Disease; GP: general practitioner.

Figure 4. Comorbidity distribution. According to whether COPD patients were managed by their respective general practitioner or for some COPD patients also managed in a secondary care outpatient clinic.

Table 2. Hospitalization admission due to exacerbation, treatment with corticosteroid and antibiotics in ICS prescribed COPD patients managed by their respective general practitioner and, for some, also managed in an outpatient clinic in secondary care.

	Managed only in primary care (n = 1719)	Also managed in an outpatient clinic in secondary care (n = 560)	P-value
Exacerbations	29.0	14.9	<0.001
No exacerbations	46.2	9.3
Admission to hospital due exacerbation	6.9	7.5	<0.001
Rescue course of corticosteroid due to exacerbation	18.3	11.5	<0.001
Antibiotic treatment for airway infection	26.0	13.6	<0.001

Notes: All variables include percentage of subjects and are based on the preceding year.

Bold text indicates statistical significance with a p-value less than 0.05.

Table 3. Characteristics of clinical relevance in included COPD patients associated with management in secondary care (n = 560) assessed by logistic regression and reported as an odds ratio (OR) and 95% confidence intervals (CI).

Characteristics associated with secondary care	OR (95% CI)	P-value
Age (years)	1.015 (0.983 − 1.048)	0.376
Pack-years	1.005 (0.993 − 1.017)	0.432
MRC ≥ 3	2.700 (1.500 − 4.857)	0.001
FEV1%pred	0.976 (0.954 − 0.998)	0.036
FEV1 (L)	1.599 (0.714 − 3.583)	0.254
Hospitalizations due to exacerbations ^a	1.428 (0.958 − 2.126)	0.080
Steroid treatment due to exacerbations ^a	1.443 (1.100 − 1.893)	0.008
Antibiotic treatment due to airway infection ^a	0.885 (0.686 − 1.143)	0.350
Concomitant asthma	0.995 (0.530 − 1.867)	0.988
Type two diabetes	0.796 (0.398 − 1.590)	0.518
Cardiovascular disease	1.136 (0.647 − 1.995)	0.656
Depression	0.543 (0.242 − 1.221)	0.140
Osteoporosis	0.896 (0.471 − 1.705)	0.738
Anxiety	2.116 (0.971 − 4.609)	0.059

Notes: The 95% confidence intervals (CI) and p-values for odds ratios (OR) were obtained from logistic regression with “secondary care” set as the reference category. For every unit added to a variable included in this analysis there is either an increase or decrease in odds.

Abbreviations: COPD, chronic obstructive pulmonary disease; MRC, Medical Research Council; FEV₁, forced expiratory volume in 1 second.

a During the preceding year.

Bold text indicates statistical significance with a p-value less than 0.05.

Data availability statement

The database will, upon request, be available from the corresponding author according to current legislation.