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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPatients with chronic obstructive pulmonary disease (COPD) have a significant respiratory disease burden in the 2 years leading up to diagnosis. This article reviews a large general practice database from the United Kingdom showed that 42% of COPD patients had one or more acute respiratory events in the 24 months prior to diagnosis.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Echronic obstructive pulmonary disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elower respiratory infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPatients with chronic obstructive pulmonary disease (COPD) have a significant respiratory disease burden in the 2 years leading up to diagnosis, according to a report that was presented by Robert Suruki, ScD, GlaxoSmithKline, Research Triangle Park, NC.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EA review of a large general practice database from the United Kingdom showed that 42% of COPD patients had one or more acute respiratory events in the 24 months prior to diagnosis. Women were more likely than men to have respiratory events prior to diagnosis, but age and Global Initiative for Obstructive Lung Disease (GOLD) stage at diagnosis were unrelated to the occurrence of acute events.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThese findings offer insight into the disease burden of patients prior to COPD diagnosis and opportunities for earlier evaluation and diagnosis, said Dr. Suruki. The study also supports evidence that fewer than 20% of patients with spirometry-confirmed COPD have been diagnosed or treated by a primary care physician prior to diagnosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ESeveral studies have documented a delay in the diagnosis of COPD, showing that COPD patients typically have one to four exacerbations a year. However, the nature and extent of respiratory disease burden prior to COPD diagnosis had not been well characterized. To address that issue, Dr. Suruki and colleagues performed a retrospective cohort study, using the General Practice Research Database (GPRD).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EInvestigators identified a cohort of 19,172 patients with new diagnoses of COPD between January 1, 2004 and December 31, 2007. Patients in the cohort had at least a 36-month history in the database, including the 24 months prior to COPD diagnosis. A new COPD diagnosis was defined as at least a 24-month COPD-free medical history prior to the entry of a COPD-related medical code into a patient\u0027s medical record. The investigators defined an acute respiratory event as a diagnosis of lower respiratory tract infection or a respiratory-related emergency room visit or hospitalization.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EPatients aged 65 years and older accounted for 59% of the cohort, followed by ages 50 to 64 years (33.5%) and 35 to 49 years (7.4%). Men and women were equally represented in the cohort.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EOverall, 41.8% of the cohort had one or more acute respiratory events that were documented in their medical records. Among patients who had an acute respiratory event, 23.7% had a single event in the 24 months prior to COPD diagnosis, 9.5% had two events, and 8.6% had three or more events.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EExamination of the relationship between age and respiratory events showed that 23.2% to 24.6% of each age group had a single acute respiratory event prior to COPD diagnosis. Similarly, the proportion of patients who had two acute events (8.8% to 9.8%) and three or more events (8.6% to 9.1%) did not differ by age group.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ESignificantly more women than men had at least one respiratory event prior to COPD diagnosis (45.9% vs 38.5%; p=0.002). Dr. Suruki reported that 24.8% of women had one event, 10.3% had two events, and 10.0% had three or more events. The figures for men were 22.6%, 8.7%, and 7.2%, respectively (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/3\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Number of Acute Respiratory Episodes in the 24 Months Preceding COPD Diagnosis.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-628950549\u0022 data-figure-caption=\u0022Number of Acute Respiratory Episodes in the 24 Months Preceding COPD Diagnosis.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/3\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/3\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/3\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11242\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003ENumber of Acute Respiratory Episodes in the 24 Months Preceding COPD Diagnosis.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from R. Suruki, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EThe event rate did not differ by COPD severity at diagnosis, as 40.2% of patients with GOLD 2 severity had at least one acute respiratory event in the 24 months prior to diagnosis, as did 44.2% of patients with either GOLD 3 or GOLD 4 status.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe GPRD medical records showed that 90% of acute respiratory events prior to COPD diagnosis were treated with antibiotics or oral corticosteroids.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EDr. Suruki acknowledged several limitations of the study. The GPRD captures only diagnoses and procedures that are recorded by general practitioners. Additionally, pneumonia-related acute respiratory events were based on reported medical codes without confirmation by chest x-rays. Finally, respiratory events that occurred during hospital-based care might not have been recorded in the GPRD.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/3\/3.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmsiq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmsiq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}