Missed Opportunities for improving outcomes in Chronic Obstructive Pulmonary Disease in underserved populations.

Research questions: To what extent is Chronic Obstructive Pulmonary Disease (COPD) under-detected in underserved (socioeconomically deprived and/or ethnic minority) populations, and what are the main reasons for this?

Why do primary care interventions (vaccination, pulmonary rehabilitation, and treatment of tobacco dependency) for supporting people with COPD fail to reach underserved populations?

Background: COPD is a preventable and treatable chronic lung disease affecting three million people in the UK and is associated with a substantial healthcare burden.

COPD is commoner in deprived communities and associated with risk factors such as smoking, air pollution and poor housing.

People living with COPD in the most deprived areas are up to ten times more likely to have poor outcomes compared to those in the least deprived areas, with increased morbidity and mortality.

Some ethnic minority groups are at higher risk of developing COPD as they are more likely to smoke and live in the most income-deprived neighbourhoods.

They are also more likely to have COPD unrelated to smoking, and first generation immigrants in particuar are likely to have alternative risk factors.

Despite this, the proportion of ethnic minorities diagnosed with COPD appear to be lower than expected, with little research conducted in this area.

Aims: To determine the burden of disease caused by COPD in under-served populations and why it may be under-estimated at present.

To explore barriers and enablers of primary care interventions (vaccination, pulmonary rehabilitation, and treatment of tobacco dependency) for people diagnosed with COPD in underserved populations.

Methods: Mixed methods, explanatory, sequential design consisting of two distinct phases: quantitative followed by qualitative.

There are five work packages (WP); WP1-2 Quantitative phase, WP3-4 Qualitative phase and WP5 Interpretation of results and intervention co-development.

Timelines for delivery: WP1 (year 1): I will estimate the number of patients with undiagnosed COPD in underserved populations nationally using publicly available data. This will be compared with prospectively collected data from WP2.

WP2 (years 1-3): The prevalence of COPD in underserved primary care populations will be established in people from underserved communities in two primary care networks.

WP3 (year 3): An understanding of barriers and facilitators to recognising COPD in underserved populations will be generated through a qualitative study, informed by WP1-2.

WP4 (year 3): An understanding of how COPD and key primary care interventions (vaccination, pulmonary rehabilitation, and treatment of tobacco dependency) are perceived by underserved populations will be generated through a qualitative study, leveraging the cohort established in WP2.

WP5 (year 5): Findings from WP1-4 will be integrated and interventions co-developed to improve recognition and management of people with COPD in underserved populations.

Anticipated Impact and Dissemination: Recognising underserved people with COPD and intervening early could reduce the burden of this condition on both patients and the health system. Primary care-based interventions improve health, reduce acute exacerbations, and are the most cost-effective for COPD.

This study provides valuable information from voices seldom heard, allowing co-development of fit for purpose interventions. I will disseminate findings through publication, social media, community groups and existing stakeholder networks.