Chronic Obstructive Pulmonary Disease (COPD) is a complex non-completely reversible respiratory condition which is emerging as a leading cause of mortality, globally. Nearly 70% of the patients go undiagnosed and diagnosis tends to happen at advanced stages of the disease. Since underlying disease process may vary significantly between COPD patients, diagnosis may present as a unique challenge. Early detection and targeted management are key concerns.
Only few studies collect detailed data, either patient-reported or observational data captured from health records, on ‘flare-ups’ (difficulty to breath upon exposure to smoke or pollution, among others, lasting for days to weeks requiring treatment and even hospitalization). The Canadian Cohort Obstructive Lung Disease (CanCOLD) is a unique urban population-based cohort with detailed follow-up data among those with early disease. Our preliminary analysis with CanCOLD suggests that indicators of deterioration observed may differ between those in early and advanced disease-stages. Here, primary-care data such as the Clinical Practice Research Datalink (CPRD) provides the opportunity to study individuals from early-stages, thus enabling us to validate findings from the CanCOLD cohort and in assessing the early disease trajectory of COPD.
Our aim is to focus attention on early detection and timely intervention strategies in COPD by contributing to bridging the gap in our understanding of early disease progression. By studying patient characteristics, we can develop care-pathways especially for those likely to experience a rapid decline. We believe this information is vital to developing new therapeutics and is also critical for healthcare systems in developing efficient care management.
Chronic Obstructive Pulmonary Disease (COPD) is a complex disease marked by partly irreversible airflow obstruction from an interplay of multiple pathological processes in an individual, making prognosis and management challenging. COPD has emerged among the leading causes of mortality globally. The current understanding of the heterogeneity of the disease and evolutions in patient management is largely based on the body of knowledge from moderate to severe patients. However, our understanding of early disease is limited, and tailored treatment approaches aimed at those susceptible to decline rapidly are needed.
Our goal is to assess the role of recently proposed clinically important deterioration (CID), in predicting future trajectory in the early disease population. COPD-patients are largely identified at advanced disease stages with 70% remaining undiagnosed.
We have assessed CID and its components in the population-based longitudinal Canadian Cohort Obstructive Lung Disease (CanCOLD) study population. This unique well- defined milder disease cohort provides a comprehensive real-life observation of disease progression not available through existing severe disease clinical study populations.
Since COPD patients are largely managed in primary care, the primary care Clinical Practice Research Database (CPRD) provides a large representative clinical cohort to validate CanCOLD findings. The Hospital Episode Statistics (HES) database containing details of all admissions including emergency attendances and outpatient appointments would permit evaluation of COPD exacerbations, an important indicator of deterioration. Association of CID and the outcomes of future disease progression will be assessed for: 1) decline in lung function and health status using logistic regression models; 2) new moderate/severe exacerbations using Cox Proportional Hazards models; and 3) the incidence of these exacerbations using Poisson regression models. This will aid the development of i) an understanding of characteristics of susceptible patients, and ii) CID definition for the milder disease population towards effective care pathways and future tailored clinical trial designs.
Primary outcome: Medium-term (up to 24 months) deterioration in lung function [using measured forced expiratory volume in one second (FEV1); Medical Research Council (MRC) Dyspnea Scale score; COPD Assessment Test (CAT) score and exacerbations].
Jean Bourbeau - Chief Investigator - Research Institute of the McGill University Health Centre
Sharmistha Biswas - Corresponding Applicant - McGill University
Benjamin Smith - Collaborator - Research Institute of the McGill University Health Centre
Dany Doiron - Collaborator - Research Institute of the McGill University Health Centre
David Buckeridge - Collaborator - McGill University
Pei Zhi Li - Collaborator - Research Institute of the McGill University Health Centre
Benjamin Smith - Collaborator - Research Institute of the McGill University Health Centre
Dany Doiron - Collaborator - Research Institute of the McGill University Health Centre
Kieran Rothnie - Collaborator - GlaxoSmithKline Services Unlimited (UK)
Pei Zhi Li - Collaborator - Research Institute of the McGill University Health Centre
Valérie Coats - Collaborator - GSK
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient