Chronic obstructive pulmonary disease (COPD) is a very common health condition that causes breathing problems. COPD is a leading cause of death worldwide, with smoking and vaping causing COPD symptoms such breathlessness for patients. COPD management is complex due to development of more than one illness at once. This is known as comorbidities. There is no cure for COPD. Reducing or stopping smoking is likely to prevent COPD symptoms from getting worse.
Stopping smoking is an essential method for relieving the symptoms of COPD. Vaping was introduced to help people stop smoking. It may be less harmful, but repeated vaping may still cause detrimental effects. The impact of this on COPD management is unknown.
Smoking and vaping can lead to bad social perceptions (stigma) in finding the cause of disease. This impacts disease management and has a negative impact on patients who smoke or vape. COPD patients with different smoking conditions may have other causes of disease and comorbidities. This may refer to current or ex-smokers.
This study will explore the difference between current smokers, ex-smokers, non-smokers, and vapers in terms of diagnosis, disease management, and comorbidities of COPD. This study will benefit the public by evaluating how smoking and vaping effects the risk of COPD and provide a better understanding towards the health effects of vaping.
COPD is a leading cause of death worldwide; the prevalence is around 174 million and it has caused 3.2 million deaths. There are about 3 million people in the UK living with COPD, which is around 4% of the population, among them only one third have been diagnosed.
Diagnosis of COPD is based on clinical symptoms and spirometry, but there is often a delay in diagnosis. The current focus of COPD treatment is on COPD prevention, stopping exacerbations, and relieving symptoms. Comorbidities are common, 97.7% of COPD patients have at least one comorbidity and the majority have at least four.
Smoking increases the risk of developing COPD. However, whether current or ex-smokers or those vaping have differing disease severity at diagnosis, are managed differently or have a different pattern of co-morbidity development is not clear.
The aim of this study is to investigate how current or former smoking or vaping impact on COPD diagnosis and management among patients in England.
We will use CPRD Aurum data linked with ONS death registration data, HES admitted patient care and patient level index of multiple deprivation. We will use descriptive statistics and compare the characteristics at the time of diagnosis in participants with different smoking conditions. We will use Cox regression models to study the time to first steroid prescription and the occurrence of comorbidity. Poisson or Negative Binomial regression models will be used to determine the number of hospital visits by a patient during the study period. This will guide further study about how the management of COPD and COPD comorbidity differs between smokers, ex-smokers, vapers and non-smokers. For example, hypertension will be selected as one of the comorbidities to focus on. We will mainly focus on the treatment for hypertension, including pharmacological treatment and non-pharmacological treatment.
Objective 1
1. Sociodemographic factors of COPD patients at the time of diagnosis
2. Disease severity of COPD patients at the time of diagnosis
3. Prevalence of comorbidities in COPD patients at the time of diagnosis
Objective 2
4. COPD management (pharmacological and non-pharmacological)
5. Health service utilisation (annual review attendance, vaccination taken for flu, COVID and pneumonia)
6. Treatment outcomes (exacerbations, mortality, and lung function)
Objective 3
7. Comorbidity management
Jennifer Quint - Chief Investigator - Imperial College London
Rong Ding - Corresponding Applicant - Imperial College London
Constantinos Kallis - Collaborator - Imperial College London
Sarah Cook - Collaborator - Imperial College London
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation