The diagnosis of COPD in primary care; gender differences and the role of spirometry

Roberts, Nicola; Patel, Irem; Partridge, Martyn R

doi:10.1016/j.rmed.2015.12.008

Cited by 20 publications

(18 citation statements)

References 8 publications

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“… 27 In general, COPD is more prevalent in males. 28 , 29 However, in our study, most of the subjects were female, and the results of our study could be related to the occupation of the subjects. The majority of the respondents were nurses, and there is a possibility that they were more interested in having their health status investigated than were doctors.…”

Section: Discussioncontrasting

confidence: 54%

Frequency of COPD in health care workers who smoke

et al. 2017

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Objective:COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods:This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results:The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions:In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

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Section: Discussioncontrasting

confidence: 54%

Frequency of COPD in health care workers who smoke

et al. 2017

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“…Regardless of these findings, the study demonstrated that there was an overall stability in statewide hospitalisation for COPD over the 5 years from 2010 to 2015 with the highest incidence occurring among metropolitan males, and contrary to previous research or projections . Further, it was highlighted that hospitalisation rates among rural females aged 65 years and over were significantly higher than their metropolitan counterparts, and consistent with the globally observed increase in the prevalence of COPD in females …”

Section: Discussioncontrasting

confidence: 49%

“…12 Further, it was highlighted that hospitalisation rates among rural females aged 65 years and over were significantly higher than their metropolitan counterparts, and consistent with the globally observed increase in the prevalence of COPD in females. 24 Overall, metropolitan males aged 85 or more years of age had the highest hospitalisation rates than all age groups and cohorts, and males aged 75 years and older were consistently higher than other cohorts of the same age. However, rural females shared a similar incidence rates with metropolitan males until the age of 75 year or older when rural female hospitalisation rates steadily decreased until they paralleled rural males and metropolitan females over the age of 85 years.…”

Section: Discussionmentioning

confidence: 88%

Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians

Terry

Nguyen

Kim

et al. 2019

Clinical Respiratory J

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Introduction Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. Objectives To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. Methods Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. Results The highest COPD incidence occurred in metropolitan males aged 85 years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P = 0.420. Conclusion This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.

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“…These differences are seen prospectively in randomized trials and cohort studies, both in primary care and specialized care. Although in lesser amount, sex differences have been studied regarding respiratory symptoms or diseases ( 9 , 27 , 28 ). However, no studies were performed in the Netherlands and the only study we found in primary care focussing on respiratory complaints has been performed in Spain with significantly fewer patients than this cohort study ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in incidence of respiratory symptoms and management by general practitioners

et al. 2020

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Background Differences between women and men play an important role in lung physiology and epidemiology of respiratory diseases, but also in the health care processes. Objective To analyse sex differences in patients encountering their general practitioner (GP) with respiratory symptoms with regard to incidence, GP’s management and final diagnoses. Methods Retrospective cohort study, using data of the Dutch Practice Based Research Network. All patients who encountered their GP from 01-07-2013 until 30-06-2018 with a new episode of care starting with a reason for encounter in the respiratory category (R) of the ICPC-2 classification were included (n = 16 773). Multi-level logistic regression was used to analyse influence of patients’ sex on management of GPs with adjustment for possible confounders. Results We found a significant higher incidence of respiratory symptoms in women than in men: 230/1000 patient years [95% confidence interval (CI) 227–232] and 186/1000 patient years (95% CI 183–189), respectively. When presenting with cough, GPs are more likely to perform physical examination [odds ratio (OR) 1.22; 95% CI 1.11–1.35] and diagnostic radiology (OR 1.25; 95% CI 1.08–1.44), but less likely to prescribe medication (OR 0.88; 95% CI 0.82–0.95) in men. When visiting the GP with dyspnoea, men more often undergo diagnostic imaging (OR 1.32; 95% CI 1.05–1.66) and are more often referred to a specialist (OR 1.35; 95% CI 1.13–1.62). Conclusions Women encounter their GP more frequently with respiratory symptoms than men and GPs perform more diagnostic investigations in men. We suggest more research in general practice focussing on sex differences and possible confounders.

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The diagnosis of COPD in primary care; gender differences and the role of spirometry

Abstract: These results may suggest a difference between genders in some of the clinical features of COPD and a difference in likelihood of a GPs provisional diagnosis of COPD being correct. The study reiterates the absolute importance of spirometry in the diagnosis of COPD.

Cited by 20 publications

References 8 publications

Frequency of COPD in health care workers who smoke

Frequency of COPD in health care workers who smoke

Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians

Sex differences in incidence of respiratory symptoms and management by general practitioners

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