Research ArticleOriginal Research

COPD Population in US Primary Care: Data From the Optimum Patient Care DARTNet Research Database and the Advancing the Patient Experience in COPD Registry

Wilson D. Pace, Elias Brandt, Victoria A. Carter, Ku-Lang Chang, Chelsea L. Edwards, Alexander Evans, Chester Fox, Gabriela Gaona, MeiLan K. Han, Alan G. Kaplan, Rachel Kent, Janwillem W. H. Kocks, Maja Kruszyk, Chantal E. Le Lievre, Tessa Li Voti, Cathy Mahle, Barry Make, Amanda R. Ratigan, Asif Shaikh, Neil Skolnik, Brooklyn Stanley, Barbara P. Yawn and David B. Price
The Annals of Family Medicine July 2022, 20 (4) 319-327; DOI: https://doi.org/10.1370/afm.2829

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Prevalence of comorbidities in COPD patients in the COPD-RD (n = 17,192) and the APEX-COPD registry (n = 1,354).

    APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database; CRS = chronic rhinosinusitis; GERD = gastresophageal reflux disease.

  • Figure 2.
    Figure 2.

    Proportion of patients included in the COPD-RD (n = 17,192) and the APEX-COPD registry (n = 1,354) and who experienced exacerbations in the last year.

    APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database.

    Note: See Supplemental Table 6 for exacerbation algorithm.

  • Figure 3.
    Figure 3.

    COPD treatment use among patients included in the COPD-RD (n = 17,192) and APEX-COPD registry (n = 1,354).

    APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database; ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; LAMA = long-acting muscarinic antagonist; LTRA = leukotriene receptor antagonist.

    a Prescribed with or without phopohodiesterase-4, macrolide, theophylline, or LTRA.

    b Prescribed with LTRA.

    c Prescribed with or without theophylline or LTRA.

Tables

  • Table 1.

    Description of Variables Used for Disease Monitoring

    VariableScoreDescription
    CT20,22<10Low impact: Most days are good, but COPD causes a few problems and stops people from doing 1-2 things they would like to do
    10-20Medium impact: COPD is one of the most important problems that they have
    21-30High impact: COPD stops people from doing most of things that they want to do
    >30Very high impact: COPD stops people from doing everything that they want to do; they never have good days
    mMRC dyspnea scale21,220Dyspnea only with strenuous exercise
    1Dyspnea when hurrying or walking up a slight hill
    2Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace
    3Stops for breath after walking 100 yards (91 m) or after a few minutes
    4Too dyspneic to leave house or breathless when dressing
    GOLD Group22ALess symptoms, low risk: mMRC 0-1, CT <10, 0 or 1 moderate or severe exacerbations (not leading to hospital admission)
    BMore symptoms, low risk: mMRC ≥2, CT ≥10, 0 or 1 moderate or severe exacerbations (not leading to hospital admission)
    CLess symptoms, high risk: mMRC 0-1, CT <10, ≥2 moderate or severe exacerbations or ≥1 leading to hospital admission
    DMore symptoms, high risk: mMRC ≥2, CT ≥10, ≥2 moderate or severe exacerbations or ≥1 leading to hospital admission

    • COPD = chronic obstructive pulmonary disease; CT = chronic obstructive pulmonary disease assessment test; GOLD = Global initiative for chronic Obstructive Lung Disease; mMRC = modified Medical Research Council.

  • Table 2.

    Demographics of COPD Patients in the COPD-RD and APEX-COPD Registry

    CharacteristicCOPD-RD (n = 17,192)APEX-COPD Registry (n = 1,354)P Value
    Site, No. (%)
      Ohio8,722 (50.7)565 (41.7) 
      North Carolina6,038 (35.1)585 (43.2) 
      New York  1,149 (6.7)  79 (5.8) 
      Texas  811 (4.7)  63 (4.7) 
      Colorado  472 (2.7)  62 (4.6) 
    Gender, No. (%)
      Female9,689 (56.4)759 (56.1).830
    Age, y
      Mean (SD)    67.4 (11.3)  69.3 (10.1) 
      35-44, No. (%)  376 (2.2)  15 (1.1) 
      45-54, No. (%)1,646 (9.6)  68 (5.0).000
      55-64, No. (%)5,182 (30.1)355 (26.2) 
      65-74, (No. %)5,400 (31.4)509 (37.6) 
      75-84, No. (%)3,307 (19.2)305 (22.5) 
      ≥85 years, No. (%)1,281 (7.5)102 (7.5) 
    BMI (kg/m2)a
      Mean (SD)    29.6 (11.1)  29.2 (8.3) 
      <18.5, underweight, No. (%)  813 (4.8)  57 (4.3).886
      18.5 to <25, normal, No. (%)4,408 (26.2)356 (26.6) 
      25 to <30, overweight, No. (%)4,670 (27.7)382 (28.6) 
      ≥30, obese, No. (%)6,958 (41.3)543 (40.6) 
    Race and ethnicity, No. (%)b
      White9,732 (63.9)749 (67.3) 
      African American3,613 (23.7)165 (14.8) 
      Hispanic1,744 (11.5)194 (17.4).484
      Asian  83 (0.5)    1 (0.1) 
      American Indian  46 (0.3)    3 (0.3) 
      Native Hawaiian    7 (0.0)    1 (0.1) 
      Multi-race    0 (0.0)    0 (0.0) 
    Smoking status, No. (%)c
      Smokers6,428 (41.2)414 (31.2) 
      Ex-smokers7,356 (47.1)751 (56.6).000
      Non-smokersd1,824 (11.7)162 (12.2) 
      Unknown smoking status1,584 (9.2)27 (2.0) 

    • APEX = Advancing the Patient Experience; BMI = body mass index; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database.

    • ↵a Data missing: COPD-RD n = 16,849, APEX-COPD n = 1,338.

    • ↵b Race and ethnicity are not mutually exclusive. Data missing: COPD-RD n = 15,225, APEX-COPD n = 1,113.

    • ↵c Data missing: APEX-COPD n = 1,327.

    • ↵d An overestimate as some ex-smokers were coded incorrectly as non-smokers at 1 site.

  • Table 3.

    Clinical Characteristics of COPD Patients in the COPD-RD and APEX-COPD Registry

    CharacteristicCOPD-RD (n = 17,192)APEX in COPD Registry (n = 1,354)P Value
    Exacerbations, No. (%)
      ≥1 exacerbation in last 12 months6,579 (38.3)EHR: 640 (47.3)
    PRIO: 646/1294 (49.9)    		.000
      ≥1 exacerbation in last 24 months9,874 (57.4)EHR: 782 (57.8).001
    Recorded vaccination, No (%)
      Influenza in the last 12 months4,561 (26.5)508 (37.5).000
      Pneumococcal in the past 10 years9,811 (57.1)881 (65.1).000
    Steady state eosinophils (cells/μL)a
      Mean (SD)212.8 (226.8)232.8 (181.8).001
      <150, No. (%)4,062 (45.7)166 (35.5) 
      150-300, No. (%)3,102 (34.9)199 (42.5) 
      >300, No. (%)1,718 (19.3)103 (22.0) 

    • APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database; EHR = electronic health record; PRIO = patient-reported information/outcome.

    • ↵a Data missing: COPD-RD n = 8,882, APEX-COPD n = 468.

  • Table 4.

    Additional PRIO Data for COPD Patients in the APEX-COPD Registry (N = 1,354)

    VariableAPEX-COPD Registry
    Sample SizeNo. (%)
    COPD assessment testn = 1,322 
      < 10 (Low) 238 (18.0)
      10-20 (Medium) 504 (38.1)
      21-30 (High) 453 (34.3)
      >30 (Very high) 127 (9.6)
    mMRCn = 1,315 
      Grade 0 258 (19.6)
      Grade 1 469 (35.7)
      Grade 2 325 (24.7)
      Grade 3 195 (14.8)
      Grade 4 68 (5.2)
    GOLD characteristicsn = 1,236 
      Less symptoms, low risk (GOLD A) 178 (14.4)
      More symptoms, low risk (GOLD B) 586 (47.4)
      Less symptoms, high risk (GOLD C) 37 (3.0)
      More symptoms, high risk (GOLD D) 435 (35.2)
    Number of exacerbations in the past 12 monthsn = 1,294 
      0 648 (50.1)
      1 241 (18.6)
      2 139 (10.7)
      3+ 266 (20.6)
    Number of hospitalizations in the past 12 monthsn = 1,246 
      0 1,000 (80.3)
      1 123 (9.9)
      2 45 (3.6)
      3+ 78 (6.2)
    Smoking statusn = 1,327 
      Smokers 414 (31.2)
      Ex-smokers 751 (56.6)
      Non-smokers 162 (12.2)

    • APEX = Advancing the Patient Experience; CT = chronic obstructive pulmonary disease assessment test; COPD = chronic obstructive pulmonary disease; GOLD = Global Initiative for chronic Obstructive Lung Disease; mMRC = modified Medical Research Council; PRI = patient reported information; PRIO = patient reported information/outcomes.

    • Note: Missing data for each variable.

  • Table 5.

    Disease Management Therapy of COPD Patients in COPD-RD and APEX-COPD Registry

    Type of TherapyInhaled TherapyCOPD-RD (n = 17,192), No. (%)APEX-COPD Registry (n = 1,354), No. (%)P Value
    NoneNo therapy    565 (3.3)103 (7.6) 
    Reliever onlySABA, SAMA, SABA+SAMA1,587 (9.2)  66 (4.9) 
    Controller therapyLABAa     46 (0.3)    4 (0.3) 
    LAMAa2,127 (12.4)  55 (4.1) 
    LABA + LAMAa2,265 (13.2)240 (17.7).000
    ICSa   756 (4.4)  47 (3.5) 
    ICS + LABAa5,070 (29.5)325 (24.0) 
    ICS + LAMAa      66 (0.4)    5 (0.4) 
    ICS + LABA + LAMAa4,658 (27.1)509 (37.6) 
    Macrolidesb8,087 (47.0)613 (45.3) 

    • APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database; ICS = inhaled corticosteroids; LABA = long-acting β2-agoninst; LAMA = long-acting muscarinic antagonist; SABA = short-acting β-agonist; SAMA = short-acting muscarinic antagonist.

    • ↵a May be prescripted with or without reliever therapy.

    • ↵b Any macrolide code in last 12 months.

Additional Files

  • SUPPLEMENTAL APPENDIX AND TABLES 1-6 IN PDF FILE BELOW
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