Patients in Remote Greenlandic Region Often Given COPD Medication Without Spirometry

The study points to the challenges of treating chronic obstructive pulmonary disease in a remote region in a country with a high smoking rate.

A new report out of a remote region of Greenland has found that many older patients were given medications for chronic obstructive pulmonary disease (COPD) without a specific diagnosis and without first undergoing spirometry.

The study suggests new strategies are needed to identify patients with COPD and to ensure that diagnostic and prescribing guidelines are followed more closely. The article was published in the International Journal of Circumpolar Health.

Corresponding author Hans Kallerup, MD, a retired physician at the Upernavik Health Center, and Mette Bordinggaard Brøndserud, MD, of the Hvidovre Hospital, in Denmark, explained that the Upernavik Health Center, the subject of the study, is located in a district of fewer than 3000 people in northwestern Greenland. The town of Upernavik contains about 39% of the region’s population, but the remaining people are spread over 9 far-apart settlements. Given the remoteness of the location, the authors said it can be difficult to decide how best to treat people who may have lung diseases like COPD.

“You must often determine whether patients can be treated and observed properly at distance in the settlement or have to be evacuated to the health care centre in Upernavik by helicopter,” they wrote. In the latter case, adverse weather conditions are often a concern.

COPD is common in Greenland, a country where half of the population smokes. The disease was one of 3 medical conditions that were the subject of a Greenlandic national lifestyle project launched in 2011 with the goal of tracking and better understanding how those conditions affected residents. Kallerup and Brøndserud decided to use data that was collected between 2011 and 2015 as part of that project to see how prevalent the use of COPD medication was in patients ages 50 and over, under what conditions it was prescribed, and how often it was prescribed with spirometry.

Out of 657 people over age 50 or above at the end of the study, 49 were prescribed medications to treat COPD (7.4%). Of those, 18 had spirometry performed within the previous 5 years, and 15 of those had diagnostic spirometry in their electronic medical record. However, most patients (35) began taking their medications an average of 4.17 years before any spirometry had been performed. The authors said these prescriptions were believed to be made based on “a clinical assumption.”

A closer look at medical records showed that in about half of cases, clinical symptoms consistent with COPD were noted. However, in some cases, no reason for the prescription was available.

“​​As found in other studies, [COPD] medications were prescribed to patients without a specific diagnosis, and without performing a spirometry,” the authors wrote. “The findings indicate the existence of a large group of undiagnosed COPD patients.”

The authors said it was not known how serious the symptoms of patients who received medication were, and the record left unclear whether such patients were given optimal follow-up treatment.

Kallerup and Brøndserud said the data showed the importance of developing better ways to identify and treat patients with COPD. They said such a program was created following the study period.

Reference:

Kallerup H and Brøndserud MB. Prevalence of users of medication targeting obstructive lung disease, the reasons for prescriptions and the use of spirometry in Upernavik health center in the period from 2011-2016, a retrospective observational study as basis for future quality development. Int J Circumpolar Health. Published online December 12, 2021. doi:10.1080/22423982.2021.2012904