AB016. Characteristics of newly diagnosed COPD patients without maintenance treatment: a population-based study
Miriam Barrecheguren1, Monica Monteagudo2, Teresa Rodriguez-Blanco2, Cristina Esquinas1, Jaume Ferrer1, Eulalia Borrell3, Pere Simonet4, Carl Llor5, Marc Miravitlles1
Background: The initial treatment patterns of chronic obstructive pulmonary disease (COPD) patients in Primary Care (PC) can differ from the guidelines recommendations. The aim of the present study was to quantify the undertreatment in newly diagnosed COPD patients and to describe the characteristics of the undertreated patients.
Methods: Population database study with data from the “System for Development in Research in Primary Care” (SIDIAP) that includes information of 5.8 millions of habitants (80% of the population of Catalonia, Spain). We identified newly diagnosed COPD patients between 2007 and 2012 by using the combination of some of the following: a codified diagnosis of COPD in the electronic clinical records, spirometry with a FEV1/FVC <70%, prescription of bronchodilator treatment after the diagnosis and/or smoking history. From this cohort we identified the undertreated patients defined as the non prescription of inhaled therapy after diagnosis or treatment only with short acting bronchodilators (SABD) and compared them to the patients that received maintenance treatment. The trend of use of diagnostic tests and treatment during the study period was studied through the average annual percent change (AAPC) in the undertreatment group.
Results: During the study period 41,492 patients were newly diagnosed of COPD. After the diagnosis, 16,221 (39%) did not received maintenance treatment. We observed no differences in age or gender distribution between treated and untreated patients. Up to 48.6% of undertreated patients were diagnosed with a spirometry vs. 40.6% of the treated patients. Mean FEV1 was 65.3% (SD 19.9%) and 56.2% (18%) in the undertreatment and maintenance treatment groups respectively. Patients in both groups were visited in PC the previous year [mean (SD): 8.3 (6.3) visits in the undertreatment group vs. 9.1 (6.9) in the maintenance treatment group], 52.2% vs. 59% had at least one exacerbation during the previous year and in total, 26.2% of the patients (22.5% undertreated vs. 28.5% treated) had two or more exacerbations. Only 10.6% of the undertreated patients and 12.7% of the patients with maintenance treatment were referred to a Pneumologist after diagnosis. During the study period, we observed a significant increase in the number of spirometries performed [AAPC: 6.71; 95% (CI) confidence interval: 2.79–10.78], an increase in SABA (AAPC: 3.01; 95% CI: 0.9–5.16), and SAMA prescription (AAPC: 8.39; 95% CI: 3.95–13.02) and a significant decrease in the number of patients without any treatment after diagnosis (AAPC: −5.63; 95% CI: −7.24, −3.98).
Conclusions: Patients that remain undertreated after diagnosis of COPD have a better lung function than patients with maintenance treatment, with no other differences. Patients in both groups had frequent previous visits to PC and up to one quarter were frequent exacerbators, so there were missed opportunities to diagnose COPD early in both groups. There is a trend towards an increase in the number of patients diagnosed with spirometry and the use of short-acting bronchodilators.
Keywords: chronic obstructive pulmonary disease (COPD); primary care (PC); newly diagnose