{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:25:35Z","timestamp":1762431935433,"version":"3.37.3"},"reference-count":15,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2020,7,30]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>COPD is a spectrum of disorders primarily caused by smoking and characterised by progressive, not fully reversible airflow obstruction with a forced expiratory volume in 1 s (FEV<jats:sub>1<\/jats:sub>)\/forced vital capacity (FVC) ratio &lt;0.7.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From November 2016 to March 2017 we audited patients with COPD in five general practices in Hull and East Riding, UK. We looked at deviation from the locally agreed guidelines. We extracted data on severity, exacerbations, medication and eosinophil count.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We assessed 1088 records. Median age was 70.9\u2005years; 577 (53%) were male. About two-thirds of patients on the COPD register have an FEV<jats:sub>1<\/jats:sub>\/FVC ratio in the diagnostic range for COPD, however, 388 (36%) out of 1088 had a ratio of \u22650.7. In the patients with a ratio of \u22650.7, 259 (67%) out of 388 had an FEV<jats:sub>1<\/jats:sub>&lt;80% of predicted. Patients with frequent exacerbations were more likely to be prescribed inhaled corticosteroid (ICS)-containing inhalers (incidence rate ratio of 2). FEV<jats:sub>1<\/jats:sub>% predicted was a poor indicator of exacerbation frequency; however, the presence of elevated blood eosinophil counts (EOS) on at least two occasions was highly predictive of exacerbations. When ICSs, FEV<jats:sub>1<\/jats:sub>, EOS were examined in combination, they were highly significant predictors for exacerbations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>FEV<jats:sub>1<\/jats:sub>maybe a more accurate diagnostic parameter in primary care. Historical evidence of blood eosinophilia is a better predictor than FEV<jats:sub>1<\/jats:sub>. The combination of biomarkers may prove more accurate indicator of future exacerbation frequency, leading to targeted intervention.<\/jats:p><\/jats:sec>","DOI":"10.1183\/23120541.00330-2020","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T13:56:53Z","timestamp":1606139813000},"page":"00330-2020","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["An audit of COPD: diagnosis and management in general practice"],"prefix":"10.1183","volume":"6","author":[{"given":"Ghassan","family":"Hamad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Rigby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyn H.","family":"Morice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"81","published-online":{"date-parts":[[2020,11,23]]},"reference":[{"key":"2024101708064432000_6.4.00330-2020.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra030415"},{"key":"2024101708064432000_6.4.00330-2020.2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209333.38"},{"key":"2024101708064432000_6.4.00330-2020.3","unstructured":"National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline. Date last accessed: 12 August 2020. Date last updated: 5 December 2018. www.nice.org.uk\/guidance\/ng115."},{"key":"2024101708064432000_6.4.00330-2020.4","unstructured":"Hull and East Riding Prescribing Committee. Prescribing guidelines, COPD treatment pathway, 2018. www.hey.nhs.uk\/wp\/wp-content\/uploads\/2016\/03\/copdTreatmentPathway.pdf Date last updated: March 2018; date last accessed: September 2019."},{"key":"2024101708064432000_6.4.00330-2020.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010099"},{"key":"2024101708064432000_6.4.00330-2020.6","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00214-2017"},{"key":"2024101708064432000_6.4.00330-2020.7","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207021"},{"key":"2024101708064432000_6.4.00330-2020.8","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.2147\/COPD.S115132","article-title":"Effectiveness using higher inhaled corticosteroid dosage in patients with COPD by different blood eosinophilic counts","volume":"11","author":"Cheng","year":"2016","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2024101708064432000_6.4.00330-2020.9","unstructured":"Health Research Authority. Decision tool. www.hra-decisiontools.org.uk\/research\/ Date last accessed: 20 October 2016; date last updated: 20 October 2016."},{"key":"2024101708064432000_6.4.00330-2020.10","unstructured":"StataCorp . Stata Statistical Software: Release 16. College Station, TX, StataCorp LLC, 2019."},{"key":"2024101708064432000_6.4.00330-2020.11","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (2018 report). https:\/\/goldcopd.org"},{"key":"2024101708064432000_6.4.00330-2020.12","unstructured":"Primary Care Strategy and NHS Contracts Group. 2019\/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) Guidance for GMS contract 2019\/20 in England April 2019. www.england.nhs.uk\/wp-content\/uploads\/2019\/05\/gms-contract-qof-guidance-april-2019.pdf Date last accessed: September 2019; date last updated: 30 April 2019."},{"key":"2024101708064432000_6.4.00330-2020.13","first-page":"PA924","article-title":"Accuracy of COPD diagnosis in primary care in Knowsley, UK","volume":"50","author":"Wat","year":"2017","journal-title":"Eur Respir J"},{"key":"2024101708064432000_6.4.00330-2020.14","first-page":"PA1577","article-title":"Accuracy of spirometers used in primary care","volume":"46","author":"Hegewald","year":"2015","journal-title":"Eur Respir J"},{"key":"2024101708064432000_6.4.00330-2020.15","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02177-2017"}],"container-title":["ERJ Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/23120541.00330-2020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:05:19Z","timestamp":1740373519000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/23120541.00330-2020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,11,23]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1183\/23120541.00330-2020"],"URL":"https:\/\/doi.org\/10.1183\/23120541.00330-2020","relation":{},"ISSN":["2312-0541"],"issn-type":[{"type":"electronic","value":"2312-0541"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}