Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

Abstract

Background: COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting.

Objectives: To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap.

Methods: COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV₁ or FVC increase ≥200 mL and ≥12%); asthma-COPD overlap was defined as post-bronchodilator FEV₁/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year.

Results: Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma-COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma-COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients.

Conclusion: COPD, asthma, and asthma-COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.

Keywords: COPD; PUMA; asthma; asthma-COPD overlap; exacerbation; health care resource utilization; primary care.

Figure 1

Prevalence of medical visits (to general practitioner/family doctor, specialist, or any physician) due to any cause or exacerbation in the last year.

Figure 2

Prevalence of medical visits (to general practitioner/family doctor, specialist, or any physician) due to any cause or exacerbation in the last year for COPD (post-bronchodilator FEV₁/FVC <0.70). Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.

Figure 3

Prevalence of medical visits (to general practitioner/family doctor, specialist, or any physician) due to any cause or exacerbation in the last year for asthma using different criteria. Abbreviation: ATS, American Thoracic Society.

Figure 4

Prevalence of medical visits (to general practitioner/family doctor, specialist, or any physician) due to any cause or exacerbation in the last year in patients with asthma–COPD overlap (post-bronchodilator FEV₁/FVC <0.70 plus asthma prior medical diagnosis), only COPD (post-bronchodilator FEV₁/FVC <0.70), only asthma (prior medical diagnosis), or without these conditions. Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.