COPD undertreatment widespread

Dec 19 2013

A study has shown that undertreatment of chronic obstructive pulmonary disease (COPD) is highly prevalent.

Data from the Copenhagen General Population Study (CGPS) showed that only 30% of patients with treatable COPD had received therapy in the previous year. And, when treatment had been initiated, it seemed to be in response to previous acute events, with a history of respiratory infections an independent predictor for treatment.

Truls Ingebrigtsen (Odense University Hospital, Denmark) and colleagues analyzed data from 920 individuals who had both a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7 and an FEV1 below 60% predicted.

Only 276 (30%) had received treatment with short- or long-acting bronchodilators, or inhaled corticosteroids, in the previous year. And, despite these patients undergoing spirometry, the results of which were sent to their general practitioners, only 42% received therapy in the year after baseline.

Logistic regression analysis showed that history of breathlessness (odds ratio [OR]=2.5), having multiple previous respiratory infections in the preceding 10 years (OR=1.9–7.9), low FEV1 (OR=1.5 per 10% decrease), being a former smoker (OR=2.4), and having previous admissions with a discharge diagnosis of COPD (OR=3.6) were independent predictors for receiving treatment in the first year of follow-up.

Conversely, cardiovascular comorbidity was significantly associated with a lack of treatment (OR=0.62).

“[W]e believe that lack of treatment with medications in the year before participation in the survey reflects both the underdiagnosis and the undertreatment that has been reported in previous population-based studies,” write Ingebrigtsen and colleagues in Chest.

“On the other hand, lack of treatment in the first year after the baseline examination most likely reflects undertreatment,” they comment.

The team also found a significant association between previous respiratory infections and likelihood for treatment, indicating that acute events are a major driver of treatment; patients with between six and 10 infections in the previous 10 years had a 7.9-fold greater odds for COPD treatment.

“Particularly in individuals with undiagnosed COPD, these acute events are highly likely to reflect exacerbations,” they note.

The team concludes: “This observation indicates that most COPD treatment may be initiated because of acute exacerbations and emphasizes a need to earlier recognize and treat symptomatic patients with FEV1 < 60% predicted.”

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