Change search
ReferencesLink to record
Permanent link

Direct link
Primary Care COPD Patients Compared with Large Pharmaceutically-Sponsored COPD Studies: An UNLOCK Validation Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Show others and affiliations
2014 (English)In: PLoS ONE, ISSN 1932-6203, Vol. 9, no 3, e90145- p.Article in journal (Refereed) Published
Abstract [en]

Background: Guideline recommendations for chronic obstructive pulmonary disease (COPD) are based on the results of large pharmaceutically-sponsored COPD studies (LPCS). There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. Objective: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD) on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. Methods: Baseline data of seven primary care databases (n = 3508) from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. Results: Overall, patients included in the LPCS were younger (mean difference (MD)-2.4; p = 0.03), predominantly male (MD 12.4; p = 0.1) with worse lung function (FEV1% MD -16.4; p < 0.01) and worse quality of life scores (SGRQ MD 15.8; p = 0.01). There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with >= 1 and >= 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had >= 1 exacerbations per year and 12% had >= 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN) to 42% (ECLIPSE, UPLIFT). Conclusion: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care populations in their recommendations.

Place, publisher, year, edition, pages
2014. Vol. 9, no 3, e90145- p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-222929DOI: 10.1371/journal.pone.0090145ISI: 000332479400050OAI: diva2:713033
Available from: 2014-04-17 Created: 2014-04-15 Last updated: 2014-04-17Bibliographically approved

Open Access in DiVA

fulltext(176 kB)62 downloads
File information
File name FULLTEXT01.pdfFile size 176 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Ställberg, BjörnLisspers, Karin
By organisation
Family Medicine and Preventive Medicine
In the same journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 62 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 244 hits
ReferencesLink to record
Permanent link

Direct link