Chest
Volume 144, Issue 6, December 2013, Pages 1811-1818
Journal home page for Chest

Original Research
COPD
Characteristics of Undertreatment in COPD in the General Population

https://doi.org/10.1378/chest.13-0453Get rights and content

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.

Section snippets

Study Populations

We used data from The Copenhagen General Population Study (CGPS).14 This ongoing study recruits individuals from the suburbs of Copenhagen, and in the current analyses we used data on 59,373 participants enrolled from 2003 through December 31, 2009. The CGPS is a prospective epidemiologic study that plans to recruit at least 100,000 individuals from the general population. This study was approved by an institutional review board and the Danish ethics committee (H-KF01-144/01) and was conducted

Demographics

Among the 920 individuals with COPD and FEV1 < 60% predicted in the CGPS examined before December 31, 2009, we identified 276 (30.0%) who received treatment with any medications in the year before their baseline examination date. Short-acting bronchodilators were received by 152 individuals (16.5%), 197 (21.4%) received long-acting bronchodilators, and 178 (19.3%) received ICSs. Table 1 shows baseline general and clinical characteristics in two groups: no treatment vs treatment with any

Discussion

In our study, we observed major undertreatment of individuals with COPD from the general population. Only 30% of individuals with medically treatable COPD were treated with any type of medication during the year before the baseline examination: 16.5% received a short-acting bronchodilator, 21.4% received a long-acting bronchodilator, and 19.3% received an ICS. Furthermore, only 42.2% were treated with any medication in the first year after having been informed about the spirometry results at

Conclusions

In conclusion, our study identified important characteristics of major undertreatment of medically treatable COPD in the general population. We identified the number of previous self-reported respiratory infections as the most important predictor of treatment in the general population. 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, thereby

Acknowledgments

Author contributions: Dr Ingebrigtsen had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data analysis and for the submission.

Dr Ingebrigtsen: contributed to the writing of the protocol, statistical analysis, analysis and interpretation of the data, and writing of the manuscript.

Mr Marott: contributed to the statistical analysis, analysis and interpretation of the data, and revision of the manuscript.

Dr Vestbo: contributed to

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    Funding/Support: These analyses were sponsored by an unrestricted grant from GlaxoSmithKline [Grant EPI 115882-EUPharmaLocal], the Capital Region of Copenhagen, the Danish Heart Foundation, the Danish Lung Foundation, the Velux Foundation, and Herlev University Hospital.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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