Asthma and COPD management of patients with intellectual disabilities in Dutch general practice

Abstract People with intellectual disabilities (ID) experience overall poorer health and healthcare access than the general population. It is largely unknown how this applies to asthma and chronic obstructive pulmonary disease (COPD) management by general practitioners (GPs). In a ten-year retrospective matched cohort study, n = 34,429, we examined year prevalence of asthma and COPD in adult patients with and without ID and potential differences in the delivery of asthma and COPD disease management activities in Dutch general practices (2010–2019). We collected information on patient characteristics, comorbidity, consultation patterns, use and outcomes of asthma/COPD control questionnaires, spirometry measurement, pulmonology referrals, and prescribed medication. Asthma patients with ID suffered more frequently from obesity (53.2% vs. 39.5% without ID), and both asthma and COPD patients with ID were more frequently current smokers (45.2% vs. 22.1% without ID and 76.6% vs. 51.4% without ID, respectively). Compared with controls, the asthma patients with ID group received overall about twice the median number of practice consultations (42 vs. 23) and telephone consultations (16 vs. 8), and a statistically significant larger number of patients were prescribed antibiotics (69.9% vs. 54.5%). The asthma year point prevalence in patients with ID was, from 2014 onward, significantly higher (8.7% vs. 6.0% in 2019). For COPD, it was comparable in both groups. However, both asthma and COPD patients with ID appeared considerably younger in age than non-ID patients. Our findings warrant further research into the causes of the differences found for asthma and COPD and whether they also infer differences in the quality or the effectiveness of GP disease management, especially for young adults with ID.