Clinical impact and healthcare resource utilization associated with early versus late COPD diagnosis in patients from UK CPRD database

Konstantinos Kostikas* (Corresponding Author), David Price, Florian S. Gutzwiller, Bethan Jones, Emil Loefroth, Andreas Clemens, Robert Fogel, Rupert Jones, Hui Cao

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
10 Downloads (Pure)


Purpose: Previous studies have shown that opportunities to diagnose chronic obstructive pulmonary disease (COPD) early are often missed in primary care. This retrospective study aimed to utilize secondary data from the United Kingdom (UK) healthcare system to understand the impact of early versus late diagnosis of COPD. 
Patients and Methods: Newly diagnosed COPD patients were identified in the UK Clinical Practice Research Database from 2011 to 2014. Patients whose 5-year medical data before diagnosis revealed ≥3 counts of eight indicators of early COPD were deemed as late diagnosed, whereas others were deemed as early diagnosed. We assessed patients’ characteristics; time-to-first, risk, and rates of exacerbation; and healthcare resource utilization (COPD-related clinic visits, Accident and Emergency visits, and hospitalizations) in late- versus early diagnosed patients. 
Results: Of 10,158 patients included in the study, 6,783 (67%) were identified as late diagnosed and 3,375 (33%) as early diagnosed. The median time-to-first exacerbation was shorter in late-diagnosed (14.5 months) versus early diagnosed (29.0 months) patients, with a significant risk of exacerbation (hazard ratio 1.46 [95% confidence interval: 1.38-1.55]). Additionally, the exacerbation rate (per 100 person-years) over 3 years was higher in late- (108.9) versus early (57.2) diagnosed patients. Patients in the late-diagnosed patients had a significantly higher rate of COPD hospitalizations (per 1,000 patient years) compared with early diagnosed patients during 2 and 3 years of follow-ups (P = 0.0165 and P < 0.0001, respectively). 
Conclusions: Results showed that a significant percentage of COPD patients in UK primary care are diagnosed late. A late COPD diagnosis is associated with a shorter time-to-first exacerbation and a higher rate and risk of exacerbations compared with early diagnosis. Additionally, late diagnosis of COPD is associated with a higher rate of COPD-related hospitalizations compared with early diagnosis.
Original languageEnglish
Pages (from-to)1729-1738
Number of pages10
JournalInternational journal of chronic obstructive pulmonary disease
Issue number15
Early online date16 Jul 2020
Publication statusPublished - 16 Jul 2020

Bibliographical note

The study was funded by Novartis AG, Basel, Switzerland.

Editorial and writing support was provided by Santanu Bhadra and Harneet Kaur (Novartis), funded by Novartis AG, Basel, Switzerland, in accordance with Good Publication Practice (GPP3) guidelines ( Data analysis was conducted by Pharmatelligence.


  • Chronic obstructive pulmonary disease/COPD
  • Clinical Practice Research Datalink/UK-CPRD
  • early diagnosis of COPD
  • late diagnosis of COPD
  • healthcare utilization
  • Clinical practice research datalink
  • Late diagnosis of COPD
  • Chronic obstructive pulmonary disease
  • Early diagnosis of COPD
  • Healthcare utilization
  • COPD
  • clinical practice research datalink
  • chronic obstructive pulmonary disease


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