COPD in primary care: from case finding to improving patient outcomes

BackgroundCOPD is an important health problem, accounting for significant health service and societal costs. However the natural history and factors affecting prognosis are poorly understood and interventions for early disease are limited. There is also considerable underdiagnosis, resulting in potential unmet need. In the UK there is interest in identifying these missing cases with diverse local initiatives, but no evidence of the most efficient approach. This programme comprises 4 workpackages (WP) to address some of these issues. Aims & objectivesThe overall aim is to set up a primary care COPD cohort including the full range of disease severity, as a platform for testing novel health service interventions. Specifically to:1. Ascertain the cost-effectiveness of the addition of active case finding, compared with opportunistic-only case finding for COPD in primary care (WP1)2. Test the validity of existing COPD prognostic indices in a primary care COPD population and develop an improved prognostic index (WP2)3. Identify factors associated with employment, absenteeism and presenteeism among those with COPD of working age (WP3)4. Assess feasibility and benefits of formal occupational health assessment among those with poor work performance (WP3)5. Assess feasibility and acceptability of a pilot intervention to promote home-based exercise among COPD patients with mild dyspnoea and mild/moderate airflow obstruction (WP4)Research plans & outputsWP1 is a randomised controlled trial to compare the effectiveness and cost-effectiveness of active versus opportunistic case finding for COPD. This will inform national policy on the most efficient approach to identifying clinically relevant cases, who can benefit from evidence based management.WP2 is the inception of the COPD cohort with 3-yr follow-up to investigate prognosis. New cases identified through WP1 will be invited to participate. In addition, all adults with documented COPD diagnosis from practices will be invited, with the aim of recruiting 2000 in total. Baseline measures will be undertaken with 6-monthly follow up for at least 3 years. A better understanding of factors that determine prognosis, particularly those that are modifiable, is essential for informing patient management decisions, and facilitating doctor patient relationships. Thus a number of prognostic indices have been developed, based on people with more advanced COPD. We will use the data collected for the cohort to examine the validity of these indices in a primary care COPD population and modify or develop a more appropriate index. This will benefit patient management in primary care, where the majority of COPD patients are cared for. The well characterised cohort will also form a platform for other health service related research within this programme and in future.A significant proportion of those with COPD are of working age, but unemployment and absenteeism rates are higher than in the general population. WP3 will use data from the cohort to examine the relationship between COPD severity and employment, occupational performance and productivity. This will inform management of COPD in workplaces, and who should be targeted for workplace interventions. A sample of patients with COPD with poorer work performance will take part in a feasibility study with an occupational health assessment and recommendations aimed at improving performance. This will inform whether such intervention has potential benefit and is feasible.Currently there are relatively few effective interventions for those with mild/moderate CODP. WP4 will focus on this group, conducting an exploratory trial to assess the feasibility and acceptability of increasing physcial activity. This will inform a future definitive trial to assess the effectiveness of the intervention in modifying disease. Research team & environmentOur multidisciplinary team consists of NHS and academic partners with subject and methodological expertise across a breadth o