People with Chronic Obstructive Pulmonary Disease (COPD) commonly experience exacerbations of COPD whereby symptoms worsen, and patients can feel more breathless and cough more than usual. Often these events require treatment with antibiotics and steroids. Patients who experience an exacerbation are more likely to have another further down the line compared to those who dont. In addition, many patients experience an exacerbation before they have been diagnosed with COPD by a doctor. By investigating exacerbations that occurred before COPD diagnosis as well as after, we can better understand the pathway and risk factors for these events. We will describe the frequency of exacerbations and how they relate to clinical burden and cost to the health care system. In addition, we aim to better understand the pathway of exacerbations from before to after COPD diagnosis.
Acute exacerbations of COPD (AECOPD) are common in patients with Chronic Obstructive Pulmonary Disease (COPD). Whilst approximately half of patients do not experience any AECOPD many patients experience many over the course of their disease. Previous studies have shown that a single AECOPD increases the risk of future multiple AECOPD. No studies have investigated the relationship between multiple AECOPD and risk of future AECOPD in this population. In addition, no studies have described the pathway of AECOPD from before COPD diagnosis to after diagnosis in order to understand the progression of AECOPD in COPD. Identifying the pattern of AECOPD across COPD progression is important in order to better identify patients who are at a higher risk of frequent AECOPD and who can be treated more efficiently. The first aim of this study is to understand the frequency of AECOPD in a COPD population and how they are related to future AECOPD, clinical burden, and health care utilization. The second aim of this study is to understand the pathway of AECOPD in newly diagnosed COPD patients and how this related to clinical burden and health care utilization.
In order to fully describe AECOPDs, their pathways and their impact in disease progression, clinical burden, and healthcare costs the following outcomes will be measured:
1) Future AECOPD events relative to previous AECOPDs (including previous LRTI).
2) Clinical burden defined as mortality rate (all cause, COPD related, and CVD related), change in lung function (FEV1), and if data allow change in breathlessness on exercise (mMRC).
3) Health care utilisation burden will be defined accounting for:
-number of GP consultations
-number of A&E visits
-number of outpatient visits
-number and length of hospitalisations
-number and length of ICU episodes (as far as possible)
-number of COPD maintenance prescriptions in the first year
-number of rescue packs prescribed (OCS +/- abx)
With the exception of prescriptions, which will be limited to COPD treatment, these measures will be estimated for both COPD related and all-cause. These outcomes will be measured in a prevalent or incident COPD cohort depending on the objective. These outcomes will be used for specific aims outlined in detail in section E. These outcomes will be measured in a prevalent or incident COPD cohort depending on the objective.
Hana Mullerova - Chief Investigator - AstraZeneca Ltd - UK Headquarters
Enrico de Nigris - Corresponding Applicant - AstraZeneca Ltd - UK Headquarters
Annalisa Rubino - Collaborator - Evidera, Inc
Divyansh Srivastava - Collaborator - ZS Associates
Eleni Rapsomaniki - Collaborator - AstraZeneca Ltd - UK Headquarters
Jennifer Quint - Collaborator - Imperial College London
John Bell - Collaborator - AstraZeneca Ltd - UK Headquarters
Keith Peres da Costa - Collaborator - ZS Associates
Precil Varghese - Collaborator - Astra Zeneca Inc - USA
Steven Kiddle - Collaborator - AstraZeneca Ltd - UK Headquarters
Tamsin Morris - Collaborator - AstraZeneca Ltd - UK Headquarters
Vasanth Radhakrishnan - Collaborator - ZS Associates
Hannah Whittaker - Corresponding Applicant - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation