Primary care cohort and prognostic index
The prognosis of COPD is not well understood, with limited treatment options, especially in people with mild/moderate disease. Prognostic indices have been largely developed in patients with more severe disease although recent indices have been proposed in primary care. These need external validation and potentially modification/improvement in large primary care populations representative of the full range of COPD severity, including undiagnosed disease, if they are to find application in clinical practice.
We plan to recruit a cohort of ~2000 new and existing COPD patients from ~70 practices in the West Midlands to establish a platform for testing novel interventions and to evaluate the validity of existing prognostic indices (and also assess the potential for improvements). These patients will be recruited from the practices involved in the case-finding trial above. They will be followed up for the duration of the programme in the first instance, with 6-monthly follow-up for 3 years. Patients will have a range of physiological and questionnaire-based measures at baseline and subsequent follow-up (eg spirometry, BMI, age, sex, ethnicity, medical history, smoking history, dyspnoea, QoL, exercise capacity, muscle strength, medications, respiratory symptoms, physical activity levels and occupation).
The primary endpoint is hospitalisation, with secondary endpoints including respiratory hospitalisations, GP consultations, exacerbations and mortality.