Clinical consequences of late Chronic Obstructive Pulmonary Disease (COPD) diagnosis compared to early diagnosis in UK primary care

Abstract

Background: Opportunities to diagnose COPD early are often missed in primary care. We examined the percentage of patients with early vs late diagnosis of COPD and investigated the clinical impact associated with late diagnosis compared to early diagnosis.

Methods: We analysed a cohort of newly diagnosed COPD patients in UK Clinical Practice Research Database from 2011 to 2014. All patients were required to have a minimum of practice data of 5 years before and 1 year after their first COPD diagnosis. Patients were deemed as late diagnosed if the review of their 5-year medical data before diagnosis revealed ≥3 counts of eight indicators of early COPD presence (such as respiratory consultation, indicative spirometry results, etc), otherwise, as early diagnosed. We assessed time to, risk of first exacerbation and rate of exacerbations in late diagnosed patients, compared to early diagnosed ones.

Results: Out of 10,158 patients, 6,783 (67%) were identified as late diagnosed and 3,375 (33%) as early diagnosed. The median time to first exacerbation from diagnosis was 14.5 vs 29.0 months for late and early diagnosed patients, respectively. An adjusted Cox proportional hazards model showed a significant HR of 1.46 (95% CI: 1.38 to 1.55) for risk of exacerbation comparing the late-diagnosed group with the early diagnosed one. The exacerbation rate per 100 person-years over 3 years was 108.9 (late) vs. 57.2 (early).

Conclusion: A late diagnosis is associated with shorter time to and higher risk of first exacerbation as well as increased exacerbation rate. In about two thirds of patients, the opportunity to diagnose COPD at an earlier stage is missed.