Identifying modifiable traits in COPD from primary care records

Background: In the UK, specialist intervention in COPD is reactive, resulting in inequalities in the provision of care. A more proactive approach, in which individuals with modifiable disease who may benefit from specialist input are identified from primary care records, may help to tackle this inequality in access.Aim: To estimate the local prevalence of modifiable disease traits in COPD in a primary care research database and to identify the health service usage of this populationMethods: This was a secondary analysis of participants in the EXCEED (Extended Cohort for E-health, Environment and DNA) cohort, a large observational study recruiting individuals aged 40-69 years old in Leicestershire, UK. Spirometry, height, weight and smoking history were collected prospectively and linked to individuals’ primary care records. Our analysis was restricted to individuals with either 1) a primary care diagnosis of COPD, or 2) obstructive spirometry and history of ever smoking. COPD with modifiable disease was defined based on published criteria (Steiner, Thorax 2015) including frequent exacerbations, current smoking, low body mass index, respiratory failure, severe breathlessness, potential suitability for lung volume reduction or psychological comorbidity.Results: In total, from 347 individuals with COPD, 186 had at least one modifiable disease trait. Individuals with modifiable traits were younger, had more severe airflow obstruction, higher eosinophil count and were more socioeconomically deprived (UK Indices of Multiple Deprivation, IMD) compared to those without modifiable disease (Table 1). Individuals with modifiable disease traits had higher annual primary care health usage. Referrals rates to specialist respiratory services were low in both groups. Conclusions: Modifiable disease traits are common in COPD and can be identified from routinely collected primary care data. Modifiable traits are associated with younger age and greater deprivation. These individuals pose a significant burden to primary care, yet are rarely referred to specialist respiratory services.