Associations with Post-Consultation Health-Status in Primary Care Managed Acute Exacerbation of COPD

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2022 Feb 25

PMID 35210767

Authors

David Gillespie

Nick Francis

Haroon Ahmed

Kerenza Hood

Carl Llor

Patrick White

Emma Thomas-Jones

Helen Stanton

Bernadette Sewell

Rhiannon Phillips

Gurudutt Naik

Hasse Melbye

Rachel Lowe

Nigel Kirby

Ann Cochrane

Janine Bates

Mohammed Fasihul Alam

Christopher Butler

Affiliations

Soon will be listed here.

Abstract

Background: It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing.

Aim: To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting.

Design And Setting: A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included.

Methods: Participants were contacted for follow-up at one- and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD.

Results: A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08-0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07-0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11-0.41), but only the two latter associations remained after adjusting for other sociodemographic variables.

Conclusion: COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.

Citing Articles

Exacerbations of COPD.

Carlin B Respir Care. 2023; 68(7):961-972.

PMID: 37353338 PMC: 10289624. DOI: 10.4187/respcare.10782.

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