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An audit of COPD: diagnosis and management in general practice

Ghassan Hamad, Alan Rigby, Alyn H. Morice
ERJ Open Research 2020 6: 00330-2020; DOI: 10.1183/23120541.00330-2020
Ghassan Hamad
Hull York Medical School, Castle Hill Hospital, Hull, UK
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  • For correspondence: ghassanhamad@yahoo.co.uk
Alan Rigby
Hull York Medical School, Castle Hill Hospital, Hull, UK
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Alyn H. Morice
Hull York Medical School, Castle Hill Hospital, Hull, UK
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  • FIGURE 1
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    FIGURE 1

    Number of exacerbations by inhaled corticosteroid (ICS) usage. a) ICS inhaler (mean number of exacerbations 1.38) and b) no ICS inhaler (mean number of exacerbnations 0.69).

  • FIGURE 2
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    FIGURE 2

    Scatter plot of forced expiratory volume in 1 s (FEV1) versus number of exacerbations in patients with >1 exacerbation. National Institute for Health and Care Excellence severity cut-off points are indicated by red vertical lines. Correlation: −0.16.

  • FIGURE 3
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    FIGURE 3

    Number of exacerbations by presence or absence of elevated blood eosinophil count (EOS). a) No EOS (mean number of exacerbations 0.80) and b) at least one positive EOS reading (mean number of exacerbations 1.30).

  • FIGURE 4
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    FIGURE 4

    Number of exacerbations by both inhaled corticosteroid (ICS) usage and elevated blood eosinophil count (EOS). a) No ICS use, no EOS (mean 0.65, 25th–75th percentiles 0–0), b) no ICS use, EOS (mean 0.75, 25th–75th percentiles 0–2), c) ICS use, no EOS (mean 0.97, 25th–75th percentiles 0–1), and d) ICS use, EOS (mean 1.76, 25th–75th percentiles 0–3).

  • FIGURE 5
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    FIGURE 5

    Predicted number of COPD exacerbations in the year preceding data collection from inhaled corticosteroid (ICS) inhaler use, elevated blood eosinophil count (EOS) and forced expiratory volume in 1 s (FEV1). Pairwise comparisons indicated ICS+EOS was significantly different from the other three groups, but no other significant differences were seen.

Tables

  • Figures
  • TABLE 1

    COPD exacerbations: relationship to raised eosinophil count (EOS), inhaled corticosteroid (ICS) treatment and forced expiratory volume in 1 s (FEV1)

    VariableUnivariable(95% CI)p-valueExcluding FEV1/FVC ratio >0.70 univariable (95% CI)p-value
    EOS at least 1 value ≥0.3×109·L−11.62(1.23−2.15)0.00061.75 (1.50−2.05)<0.0001
    EOS single elevated reading1.40(0.84−2.42)0.182.21 (1.71−2.86)<0.0001
    EOS ≥2 readings1.63(1.11−2.40)0.0131.84 (1.48−2.78)<0.0001
    ICS inhaler2(1.51−2.63)<0.00012.13 (1.81−2.51)<0.0001
    FEV1 % predicted0.98(0.97−0.99)<0.00010.98 (0.98−0.99)<0.0001

    Data are presented as incidence rate ratios. FVC: forced vital capacity.

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    Vol 6 Issue 4 Table of Contents
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    An audit of COPD: diagnosis and management in general practice
    Ghassan Hamad, Alan Rigby, Alyn H. Morice
    ERJ Open Research Oct 2020, 6 (4) 00330-2020; DOI: 10.1183/23120541.00330-2020

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    An audit of COPD: diagnosis and management in general practice
    Ghassan Hamad, Alan Rigby, Alyn H. Morice
    ERJ Open Research Oct 2020, 6 (4) 00330-2020; DOI: 10.1183/23120541.00330-2020
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