title: Trends in management and outcomes of COPD patients in primary care, 2000-2009: a retrospective cohort study.
abstract: BACKGROUND
  Since the introduction of the Quality and Outcomes framework, there has been some evidence of improvement in the management of chronic obstructive pulmonary disease (COPD) patients in the United Kingdom through increasing rates of smoking cessation advice and immunisations against influenza. However, it is unknown whether disease-specific management criteria, disease outcomes and diagnosis have improved.
  
  
  OBJECTIVE
  To describe changes in the management and outcomes of patients with COPD in UK general practice between 2000 and 2009.
  
  
  METHODS
  The study was done on a retrospective cohort using data from The Health Improvement Network UK primary care database. We calculated age at diagnosis of COPD and death, total number of short-term oral corticosteroid courses and consultations, and proportion of patients with very severe COPD and on triple inhaled therapy for each year between 2000 and 2009.
  
  
  RESULTS
  We identified 92,576 patients with COPD. The mean age at COPD diagnosis decreased from 68.1 years in 2000 to 66.7 years in 2009. The mean age at death increased from 78.2 years in 2000 to 78.8 years in 2009. The number of prescribed courses of oral corticosteroids increased from 0.6 in 2000 to 0.8 in 2009. The number of consultations increased from 9.4 in 2004 to 11.3 in 2009. The risk of having very severe COPD decreased from 9.4% in 2004 to 6.8% in 2009. The likelihood of patients with very severe COPD receiving triple therapy increased from 25% in 2004 to 59% in 2009.
  
  
  CONCLUSIONS
  The trends suggest that management and outcomes observed in patients with COPD may have improved since the year 2000.
authors.affiliation: 1] Department of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Hampstead, London, UK [2] Centre for Respiratory Medicine, University College London, Royal Free Campus, Hampstead, London, UK.
authors.forename: Gareth D
authors.initials: GD
authors.lastname: James
authors.affiliation: Centre for Respiratory Medicine, University College London, Royal Free Campus, Hampstead, London, UK.
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Donaldson
authors.affiliation: Centre for Respiratory Medicine, University College London, Royal Free Campus, Hampstead, London, UK.
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.affiliation: Department of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Hampstead, London, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011320:Primary Health Care / Q000592:standards / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D011787:Quality of Health Care / Q000639:trends; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents