An audit of COPD: diagnosis and management in general practice
Introduction COPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7. Methods From November 2016 to March 2017 we audited patients wi...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2020-11-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/6/4/00330-2020.full |
| _version_ | 1811270907048493056 |
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| author | Ghassan Hamad Alan Rigby Alyn H. Morice |
| author_facet | Ghassan Hamad Alan Rigby Alyn H. Morice |
| author_sort | Ghassan Hamad |
| collection | DOAJ |
| description | Introduction
COPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7.
Methods
From November 2016 to March 2017 we audited patients with COPD in five general practices in Hull and East Riding, UK. We looked at deviation from the locally agreed guidelines. We extracted data on severity, exacerbations, medication and eosinophil count.
Results
We assessed 1088 records. Median age was 70.9 years; 577 (53%) were male. About two-thirds of patients on the COPD register have an FEV1/FVC ratio in the diagnostic range for COPD, however, 388 (36%) out of 1088 had a ratio of ≥0.7. In the patients with a ratio of ≥0.7, 259 (67%) out of 388 had an FEV1 <80% of predicted. Patients with frequent exacerbations were more likely to be prescribed inhaled corticosteroid (ICS)-containing inhalers (incidence rate ratio of 2). FEV1 % predicted was a poor indicator of exacerbation frequency; however, the presence of elevated blood eosinophil counts (EOS) on at least two occasions was highly predictive of exacerbations. When ICSs, FEV1, EOS were examined in combination, they were highly significant predictors for exacerbations.
Conclusion
FEV1 maybe a more accurate diagnostic parameter in primary care. Historical evidence of blood eosinophilia is a better predictor than FEV1. The combination of biomarkers may prove more accurate indicator of future exacerbation frequency, leading to targeted intervention. |
| first_indexed | 2024-04-12T22:11:43Z |
| format | Article |
| id | doaj.art-3d24282cb26b40eda5c6f5e31392dc17 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-04-12T22:11:43Z |
| publishDate | 2020-11-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-3d24282cb26b40eda5c6f5e31392dc172022-12-22T03:14:44ZengEuropean Respiratory SocietyERJ Open Research2312-05412020-11-016410.1183/23120541.00330-202000330-2020An audit of COPD: diagnosis and management in general practiceGhassan Hamad0Alan Rigby1Alyn H. Morice2 Hull York Medical School, Castle Hill Hospital, Hull, UK Hull York Medical School, Castle Hill Hospital, Hull, UK Hull York Medical School, Castle Hill Hospital, Hull, UK Introduction COPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7. Methods From November 2016 to March 2017 we audited patients with COPD in five general practices in Hull and East Riding, UK. We looked at deviation from the locally agreed guidelines. We extracted data on severity, exacerbations, medication and eosinophil count. Results We assessed 1088 records. Median age was 70.9 years; 577 (53%) were male. About two-thirds of patients on the COPD register have an FEV1/FVC ratio in the diagnostic range for COPD, however, 388 (36%) out of 1088 had a ratio of ≥0.7. In the patients with a ratio of ≥0.7, 259 (67%) out of 388 had an FEV1 <80% of predicted. Patients with frequent exacerbations were more likely to be prescribed inhaled corticosteroid (ICS)-containing inhalers (incidence rate ratio of 2). FEV1 % predicted was a poor indicator of exacerbation frequency; however, the presence of elevated blood eosinophil counts (EOS) on at least two occasions was highly predictive of exacerbations. When ICSs, FEV1, EOS were examined in combination, they were highly significant predictors for exacerbations. Conclusion FEV1 maybe a more accurate diagnostic parameter in primary care. Historical evidence of blood eosinophilia is a better predictor than FEV1. The combination of biomarkers may prove more accurate indicator of future exacerbation frequency, leading to targeted intervention.http://openres.ersjournals.com/content/6/4/00330-2020.full |
| spellingShingle | Ghassan Hamad Alan Rigby Alyn H. Morice An audit of COPD: diagnosis and management in general practice ERJ Open Research |
| title | An audit of COPD: diagnosis and management in general practice |
| title_full | An audit of COPD: diagnosis and management in general practice |
| title_fullStr | An audit of COPD: diagnosis and management in general practice |
| title_full_unstemmed | An audit of COPD: diagnosis and management in general practice |
| title_short | An audit of COPD: diagnosis and management in general practice |
| title_sort | audit of copd diagnosis and management in general practice |
| url | http://openres.ersjournals.com/content/6/4/00330-2020.full |
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