Characteristics of undertreatment in COPD in the general population

Truls S Ingebrigtsen; Jacob L Marott; Jørgen Vestbo; Jesper Hallas; Børge G Nordestgaard; Morten Dahl; Peter Lange

doi:10.1378/chest.13-0453

Characteristics of undertreatment in COPD in the general population

Truls S Ingebrigtsen, Jacob L Marott, Jørgen Vestbo, Jesper Hallas, Børge G Nordestgaard, Morten Dahl, Peter Lange

24 Citations (Scopus)

Abstract

Background: We wished to characterize undertreatment in COPD. Methods: Among 5,812 individuals with COPD defined by FEV₁/FVC < 0.7 participating in the Copenhagen General Population Study, we identified 920 individuals with FEV₁ < 60% predicted. Prescriptions were identified in an all-inclusive nationwide registry. For each individual, we examined treatment with medication in the year before the day of the baseline examination, as well as treatment in the first year after the examination. Multivariable logistic regression analyses were applied in individuals with FEV₁ < 60% predicted to identify predictors of treatment in the first year after baseline. Results: Only 30% of individuals with COPD and FEV₁ < 60% predicted were treated with medication in the year before the examination, whereas 42.2% were treated with medication in the first year after. Reporting six to 10 previous respiratory infections during the preceding 10 years that required consulting a doctor and/or staying home from work was the strongest predictor of treatment with medication (OR, 7.9; 95% CI, 3.5-19.8; P < .001). Breathlessness, low FEV₁, previous admissions with a discharge diagnosis of COPD, and former smoking were also predictors of treatment with medication, whereas comorbidity predicted lack of treatment. In subgroup analysis, among individuals with FEV₁ < 50% predicted, visits to the general practitioner and age were additional predictors of treatment, whereas male sex and being a widow/widower predicted lack of treatment. Conclusions: In this study, we observed important characteristics of a major undertreatment in individuals with COPD in the general population. Previous reported respiratory infections were the strongest predictors of treatment with medications, which indicates that most COPD treatment is initiated because of acute exacerbations.

Original language	English
Journal	Chest
Volume	144
Issue number	6
Pages (from-to)	1811-8
Number of pages	8
ISSN	0012-3692
DOIs	https://doi.org/10.1378/chest.13-0453
Publication status	Published - Dec 2013

Keywords

Administration, Inhalation
Adrenal Cortex Hormones
Aged
Bronchodilator Agents
Cohort Studies
Denmark
Female
Forced Expiratory Volume
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive
Regression Analysis
Respiratory Function Tests
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Vital Capacity

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10.1378/chest.13-0453

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title = "Characteristics of undertreatment in COPD in the general population",

abstract = "Background: We wished to characterize undertreatment in COPD. Methods: Among 5,812 individuals with COPD defined by FEV1/FVC < 0.7 participating in the Copenhagen General Population Study, we identified 920 individuals with FEV1 < 60% predicted. Prescriptions were identified in an all-inclusive nationwide registry. For each individual, we examined treatment with medication in the year before the day of the baseline examination, as well as treatment in the first year after the examination. Multivariable logistic regression analyses were applied in individuals with FEV1 < 60% predicted to identify predictors of treatment in the first year after baseline. Results: Only 30% of individuals with COPD and FEV1 < 60% predicted were treated with medication in the year before the examination, whereas 42.2% were treated with medication in the first year after. Reporting six to 10 previous respiratory infections during the preceding 10 years that required consulting a doctor and/or staying home from work was the strongest predictor of treatment with medication (OR, 7.9; 95% CI, 3.5-19.8; P < .001). Breathlessness, low FEV1, previous admissions with a discharge diagnosis of COPD, and former smoking were also predictors of treatment with medication, whereas comorbidity predicted lack of treatment. In subgroup analysis, among individuals with FEV1 < 50% predicted, visits to the general practitioner and age were additional predictors of treatment, whereas male sex and being a widow/widower predicted lack of treatment. Conclusions: In this study, we observed important characteristics of a major undertreatment in individuals with COPD in the general population. Previous reported respiratory infections were the strongest predictors of treatment with medications, which indicates that most COPD treatment is initiated because of acute exacerbations.",

keywords = "Administration, Inhalation, Adrenal Cortex Hormones, Aged, Bronchodilator Agents, Cohort Studies, Denmark, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Regression Analysis, Respiratory Function Tests, Retrospective Studies, Severity of Illness Index, Treatment Outcome, Vital Capacity",

author = "Ingebrigtsen, {Truls S} and Marott, {Jacob L} and J{\o}rgen Vestbo and Jesper Hallas and Nordestgaard, {B{\o}rge G} and Morten Dahl and Peter Lange",

year = "2013",

month = dec,

doi = "10.1378/chest.13-0453",

language = "English",

volume = "144",

pages = "1811--8",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "6",

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TY - JOUR

T1 - Characteristics of undertreatment in COPD in the general population

AU - Ingebrigtsen, Truls S

AU - Marott, Jacob L

AU - Vestbo, Jørgen

AU - Hallas, Jesper

AU - Nordestgaard, Børge G

AU - Dahl, Morten

AU - Lange, Peter

PY - 2013/12

Y1 - 2013/12

N2 - Background: We wished to characterize undertreatment in COPD. Methods: Among 5,812 individuals with COPD defined by FEV1/FVC < 0.7 participating in the Copenhagen General Population Study, we identified 920 individuals with FEV1 < 60% predicted. Prescriptions were identified in an all-inclusive nationwide registry. For each individual, we examined treatment with medication in the year before the day of the baseline examination, as well as treatment in the first year after the examination. Multivariable logistic regression analyses were applied in individuals with FEV1 < 60% predicted to identify predictors of treatment in the first year after baseline. Results: Only 30% of individuals with COPD and FEV1 < 60% predicted were treated with medication in the year before the examination, whereas 42.2% were treated with medication in the first year after. Reporting six to 10 previous respiratory infections during the preceding 10 years that required consulting a doctor and/or staying home from work was the strongest predictor of treatment with medication (OR, 7.9; 95% CI, 3.5-19.8; P < .001). Breathlessness, low FEV1, previous admissions with a discharge diagnosis of COPD, and former smoking were also predictors of treatment with medication, whereas comorbidity predicted lack of treatment. In subgroup analysis, among individuals with FEV1 < 50% predicted, visits to the general practitioner and age were additional predictors of treatment, whereas male sex and being a widow/widower predicted lack of treatment. Conclusions: In this study, we observed important characteristics of a major undertreatment in individuals with COPD in the general population. Previous reported respiratory infections were the strongest predictors of treatment with medications, which indicates that most COPD treatment is initiated because of acute exacerbations.

AB - Background: We wished to characterize undertreatment in COPD. Methods: Among 5,812 individuals with COPD defined by FEV1/FVC < 0.7 participating in the Copenhagen General Population Study, we identified 920 individuals with FEV1 < 60% predicted. Prescriptions were identified in an all-inclusive nationwide registry. For each individual, we examined treatment with medication in the year before the day of the baseline examination, as well as treatment in the first year after the examination. Multivariable logistic regression analyses were applied in individuals with FEV1 < 60% predicted to identify predictors of treatment in the first year after baseline. Results: Only 30% of individuals with COPD and FEV1 < 60% predicted were treated with medication in the year before the examination, whereas 42.2% were treated with medication in the first year after. Reporting six to 10 previous respiratory infections during the preceding 10 years that required consulting a doctor and/or staying home from work was the strongest predictor of treatment with medication (OR, 7.9; 95% CI, 3.5-19.8; P < .001). Breathlessness, low FEV1, previous admissions with a discharge diagnosis of COPD, and former smoking were also predictors of treatment with medication, whereas comorbidity predicted lack of treatment. In subgroup analysis, among individuals with FEV1 < 50% predicted, visits to the general practitioner and age were additional predictors of treatment, whereas male sex and being a widow/widower predicted lack of treatment. Conclusions: In this study, we observed important characteristics of a major undertreatment in individuals with COPD in the general population. Previous reported respiratory infections were the strongest predictors of treatment with medications, which indicates that most COPD treatment is initiated because of acute exacerbations.

KW - Administration, Inhalation

KW - Adrenal Cortex Hormones

KW - Aged

KW - Bronchodilator Agents

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Forced Expiratory Volume

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Pulmonary Disease, Chronic Obstructive

KW - Regression Analysis

KW - Respiratory Function Tests

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Treatment Outcome

KW - Vital Capacity

U2 - 10.1378/chest.13-0453

DO - 10.1378/chest.13-0453

M3 - Journal article

C2 - 23989916

SN - 0012-3692

VL - 144

SP - 1811

EP - 1818

JO - Chest

JF - Chest

IS - 6

ER -

Characteristics of undertreatment in COPD in the general population

Abstract

Keywords

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