Primary care physicians need guidance on managing COPD

More real-life effectiveness studies would help, researchers say in new study.

Patients with chronic obstructive pulmonary disease (COPD) need treatment and more real-life effectiveness trials are needed to support decision-making by their primary care physicians.

A new study outlined the state of 16 million COPD patients, their treatments and what primary care physicians need to know about them in the United States.

“COPD Population in U.S. Primary Care: Data from the Optimum Patient Care DARTNet Research Database and the Advancing the Patient Experience in COPD Registry,” examined the high exacerbation, symptom and treatment burdens experienced by 17,192 COPD patients across five states. About 80% of COPD patients are managed by family physicians or general internists, but may family physicians and primary care clinicians are unfamiliar with COPD management guidelines.

Those guidelines “may not reflect routine clinical practice, as the majority of the their evidence is derived from randomized controlled trials (RCTs) rather than real-life effectiveness studies,” said the report published in the Annals of Family Medicine.

COPD is the third leading cause of death in the United States, claiming 140,000 patients a year. The COPD death rate has doubled since 1969, and the economic effect is projected to be $800.9 billion from direct medical costs and $101.3 billion from indirect absenteeism, from 2019 to 2038, according to the study.

Health experts published the COPD National Action Plan and created the Advancing the Patient Experience in COPD, known as APEX-COPD, the first primary care health system-based COPD registry in the United States, the study said. It collects electronic health record data from a larger dataset known as the COPD Optimum Patient Care Research DARTNet Research Database (COPD-RD).

Among the COPD-RD patients, 56% were female, 81% were aged 55 to 84 years, 64% were white, 88% were smokers or ex-smokers, and 69% were overweight or obese. For comorbities, 99% of patients reported at least one and 87% reported three or more. Hypertension was the most predominant (73%), followed by diabetes mellitus (45%), depression (42%) and osteoarthritis (41%). Findings were similar among patients in the APEX-COPD registry, and the study examined exacerbations and treatments.

“It is important to accurately characterized COPD in primary care since it carries a high morbidity and socioeconomic burden, is associated with more hospitalizations, longer hospital stays, and more emergency department visits (unrelated to COPD),” the study said.