Quantification of variations in outcomes of respiratory care in Wessex: three COPD projects using the Hampshire Health Record

Theme 1

Integrated Respiratory Care

We used routinely collected, anonymised information in the Hampshire Health Record Analytical database (HHRA) to study all patients (over 16,000) with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) in their GP records. We examind the health outcomes in these patients over a three year period (2011-2013), looking at deaths and hospital A&E attendance or admission because of worsening breathing problems.

We also examined the impact on these COPD patients of other long-term diseases, such as heart disease, diabetes or osteoporosis. Most people with COPD have breathing tests that confirm the diagnosis, however some patients with similar symptoms do not, and our study will aim to understand this situation and will compare the health outcomes of both these groups of patients.

Outcomes.

  1. Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study. It shows a 17-22% reduction in the risk of death and respiratory-cause hospitalisation in ex-smokers compared to active smokers.

  2. The relationship between BMI and COPD outcomes. The analyses have shown that being underweight is associated with poor prognosis, but obese and very obese patients paradoxically have a reduced mortality and hospitalisation. The analyses are complete and the 2nd draft of the paper is being revised at the moment.

  3. Absent airflow obstruction (AFO) has been found in 15% of our large COPD cohort, suggesting that these patients may be misdiagnosed with COPD. So far, we have characterised the 16479 patients and categorised them according to whether they have evidence of AFO; we are about to analyse outcomes (mortality, hospitalisation) and compare outcomes in the various categories and then look at treatment (to highlight possibly inappropriate treatment in those without AFO). This project is especially important from a clinical prospective. Statistical analysis ongoing,

  4. Preliminary analyses of comorbidities in our cohort have shown that generally comorbidities are associated with worse outcomes. However, gastro-oesophageal reflux (GORD) is associated with reduced mortality risk. This might be due to treatment and some drugs may have anti-inflammatory properties that benefit COPD. The coding of relevant medications has been completed. Statistical analysis ongoing.

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Dr David Culiford

Professor Mike Thomas


University of Southampton

University Hospital Southampton NHS Foundation Trust

Portsmouth Hospitals NHS Trust

Southern Health NHS Foundation Trust

Hampshire Hospitals NHS Foundation Trust

Solent NHS Trust

Isle of Wight NHS Primary Care NHS Trust

NHS West Hampshire CCG

NHS Southampton City CCG

NHS Portsmouth CCG

NHS North East Hampshire and Farnham CCG

NHS North Hampshire CCG

NHS South Eastern Hampshire CCG

NHS Fareham and Gosport CCG

NHS Isle of Wight CCG

Health Education Wessex


CLAHRC COPD Summary

Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study