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Original Research: COPD |

Characteristics of Undertreatment in COPD in the General PopulationCharacteristics of Undertreatment in COPD

Truls S. Ingebrigtsen, MD; Jacob L. Marott, MSc; Jørgen Vestbo, MD, DMSc; Jesper Hallas, MD, DMSc; Børge G. Nordestgaard, MD, DMSc; Morten Dahl, MD, DMSc; Peter Lange, MD, DMSc
Author and Funding Information

From the Department of Respiratory Medicine (Drs Ingebrigtsen and Vestbo) and the Department of Clinical Pharmacology (Dr Hallas), Odense University Hospital and Clinical Institute, University of Southern Denmark, Odense, Denmark; The Copenhagen City Heart Study (Drs Ingebrigtsen and Lange and Mr Marott), Frederiksberg Hospital, Copenhagen, Denmark; the Department of Clinical Biochemistry (Dr Nordestgaard) and The Copenhagen General Population Study (Dr Nordestgaard), Herlev Hospital, the Department of Clinical Biochemistry (Dr Dahl), Rigshospitalet, and the Respiratory Section (Dr Lange), Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark; the Department of Social Medicine (Dr Lange), Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; and the Respiratory Research Group (Dr Vestbo), Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, England.

Correspondence to: Truls S. Ingebrigtsen, MD, Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; e-mail: trulsingebrigtsen@gmail.com


Funding/Support: These analyses were sponsored by an unrestricted grant from GlaxoSmithKline [Grant EPI 115882-EUPharmaLocal], the Capital Region of Copenhagen, the Danish Heart Foundation, the Danish Lung Foundation, the Velux Foundation, and Herlev University Hospital.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1811-1818. doi:10.1378/chest.13-0453
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Background:  We wished to characterize undertreatment in COPD.

Methods:  Among 5,812 individuals with COPD defined by FEV1/FVC < 0.7 participating in the Copenhagen General Population Study, we identified 920 individuals with FEV1 < 60% predicted. Prescriptions were identified in an all-inclusive nationwide registry. For each individual, we examined treatment with medication in the year before the day of the baseline examination, as well as treatment in the first year after the examination. Multivariable logistic regression analyses were applied in individuals with FEV1 < 60% predicted to identify predictors of treatment in the first year after baseline.

Results:  Only 30% of individuals with COPD and FEV1 < 60% predicted were treated with medication in the year before the examination, whereas 42.2% were treated with medication in the first year after. Reporting six to 10 previous respiratory infections during the preceding 10 years that required consulting a doctor and/or staying home from work was the strongest predictor of treatment with medication (OR, 7.9; 95% CI, 3.5-19.8; P < .001). Breathlessness, low FEV1, previous admissions with a discharge diagnosis of COPD, and former smoking were also predictors of treatment with medication, whereas comorbidity predicted lack of treatment. In subgroup analysis, among individuals with FEV1 < 50% predicted, visits to the general practitioner and age were additional predictors of treatment, whereas male sex and being a widow/widower predicted lack of treatment.

Conclusions:  In this study, we observed important characteristics of a major undertreatment in individuals with COPD in the general population. Previous reported respiratory infections were the strongest predictors of treatment with medications, which indicates that most COPD treatment is initiated because of acute exacerbations.


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