Longitudinal changes in COPD patients in primary care

We describe the change in COPD outcomes over time in a cohort managed in primary care. Methods: The ACCESS (Assessment of Comorbidities in COPD in European Symptomatic Subjects; 115058 study; NCT01516528) was an observational study that prospectively recruited COPD patients across Europe. There were minimal exclusion criteria, but a significant smoking history was required. COPD outcomes collected over 24 months included COPD Assessment Test (CAT), COPD exacerbations, and airflow limitation. Change over time (from screening for FEV 1 [L]; from baseline for CAT) was described as a difference. A mixed linear model was used to explain the change in CAT score (annual) with baseline traits (country, age, gender, CVD comorbidity, smoking, exacerbations prior to study, CAT score) and exacerbations during the study period as covariates. Results: 2887 COPD patients (mean age: 66yrs; 30% females; mean of 59% FEV 1 % predicted, 0.61 exacerbations/person-year) had at screening FEV 1 mean of 1.68L [95% CI: 1.66;1.71]; Mean change in FEV 1 was 30.6mL (95%CI:12.8;48.4; N=2208) at 12M and -55.6mL [95%CI:-73.9;-37.3;N=1894] 12M to 24M . At baseline, mean CAT score was 15.0 [95%CI: 14.7;15.3]. Mean change in CAT score was mean of -0.04 score [95%CI: - -0.28, 0.21; N=2646] at 12M and 1.01 [95%CI: 0.74; 1.27; N=2342] at 24 M. Change in CAT score change was predicted both by FEV 1 and by CAT score at baseline and exacerbations during the study. Conclusions: In this large, well-defined, primary care cohort of COPD patients, a wide variation in disease progression was observed, with sustained worsening on average. CAT score change over two years was predicted by exacerbation frequency during the follow-up and disease severity traits. Funded by GSK.