Showing papers by "Hana Müllerová published in 2017"

Validation of asthma recording in the Clinical Practice Research Datalink (CPRD).

Abstract: Objectives The optimal method of identifying people with asthma from electronic health records in primary care is not known. The aim of this study is to determine the positive predictive value (PPV) of different algorithms using clinical codes and prescription data to identify people with asthma in the United Kingdom Clinical Practice Research Datalink (CPRD). Methods 684 participants registered with a general practitioner (GP) practice contributing to CPRD between 1 December 2013 and 30 November 2015 were selected according to one of eight predefined potential asthma identification algorithms. A questionnaire was sent to the GPs to confirm asthma status and provide additional information to support an asthma diagnosis. Two study physicians independently reviewed and adjudicated the questionnaires and additional information to form a gold standard for asthma diagnosis. The PPV was calculated for each algorithm. Results 684 questionnaires were sent, of which 494 (72%) were returned and 475 (69%) were complete and analysed. All five algorithms including a specific Read code indicating asthma or non-specific Read code accompanied by additional conditions performed well. The PPV for asthma diagnosis using only a specific asthma code was 86.4% (95% CI 77.4% to 95.4%). Extra information on asthma medication prescription (PPV 83.3%), evidence of reversibility testing (PPV 86.0%) or a combination of all three selection criteria (PPV 86.4%) did not result in a higher PPV. The algorithm using non-specific asthma codes, information on reversibility testing and respiratory medication use scored highest (PPV 90.7%, 95% CI (82.8% to 98.7%), but had a much lower identifiable population. Algorithms based on asthma symptom codes had low PPVs (43.1% to 57.8%)%). Conclusions People with asthma can be accurately identified from UK primary care records using specific Read codes. The inclusion of spirometry or asthma medications in the algorithm did not clearly improve accuracy. Ethics and dissemination The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number15_257) and the approved protocol was made available to the journal and reviewers during peer review. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority Research Ethics Committee (East Midlands—Derby, REC reference number 05/MRE04/87). The results will be submitted for publication and will be disseminated through research conferences and peer-reviewed journals.

Validity and interpretation of spirometric recordings to diagnose COPD in UK primary care.

Abstract: Background The diagnosis of COPD is dependent upon clinical judgment and confirmation of the presence of airflow obstruction using spirometry. Spirometry is now routinely available; however, spirometry incorrectly performed or interpreted can lead to misdiagnosis. We aimed to determine whether spirometry undertaken in primary care for patients suspected to have COPD was of sufficient quality and whether their spirometry was correctly interpreted. Methods Two chest physicians re-read all spirometric readings for both quality of the procedure and interpretation, received as a part of COPD validation studies using data from the Clinical Practice Research Datalink (CPRD). We then used logistic regression to investigate predictors of correct interpretation. Results Spirometry traces were obtained for 306 patients, of which 221 (72.2%) were conducted in primary care. Of those conducted in primary care, 98.6% (n=218) of spirometry traces were of adequate quality. Of those traces that were of adequate quality and conducted in primary care, and in whom a general practitioner (GP) diagnosis of COPD had been made, 72.5% (n=218) were consistent with obstruction. Historical records for asthma diagnosis significantly decreased odds of correct interpretation. Conclusion The quality of the spirometry procedure undertaken in primary care is high. However, this was not reflected in the quality of interpretation, suggesting an unmet training in primary care. The quality of the spirometry procedure as demonstrated by spirometric tracings provides a re-assurance for the use of spirometric values available in the electronic health care record databases for research purposes.

The PLATINO study: description of the distribution, stability, and mortality according to the Global Initiative for Chronic Obstructive Lung Disease classification from 2007 to 2017.

Abstract: Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report provides a framework for classifying COPD reflecting the impacts of disease on patients and for targeting treatment recommendations The GOLD 2017 introduced a new classification with 16 subgroups based on a composite of spirometry and symptoms/exacerbations Methods Data from the population-based PLATINO study, collected at baseline and at follow-up, in three sites in Latin America were analyzed to compare the following: 1) the distribution of COPD patients according to GOLD 2007, 2013, and 2017; 2) the stability of the 2007 and 2013 classifications; and 3) the mortality rate over time stratified by GOLD 2007, 2013, and 2017 Results Of the 524 COPD patients evaluated, most of them were classified as Grade I or II (GOLD 2007) and Group A or B (GOLD 2013), with ≈70% of those classified as Group A in GOLD 2013 also classified as Grade I in GOLD 2007 and the highest percentage (41%) in Group D (2013) classified as Grade III (2007) According to GOLD 2017, among patients with Grade I airflow limitation, 69% of them were categorized into Group A, whereas Grade IV patients were more evenly distributed among Groups A-D Most of the patients classified by GOLD 2007 remained in the same airflow limitation group at the follow-up; a greater temporal variability was observed with GOLD 2013 classification Incidence-mortality rate in patients classified by GOLD 2007 was positively associated with increasing severity of airflow obstruction; for GOLD 2013 and GOLD 2017 (Groups A-D), highest mortality rates were observed in Groups C and D No clear pattern was observed for mortality across the GOLD 2017 subgroups Conclusion The PLATINO study data suggest that GOLD 2007 classification shows more stability over time compared with GOLD 2013 No clear patterns with respect to the distribution of patients or incidence-mortality rates were observed according to GOLD 2013/2017 classification

Validation of asthma recording in electronic health records: a systematic review.

Abstract: Objective To describe the methods used to validate asthma diagnoses in electronic health records and summarize the results of the validation studies. Background Electronic health records are increasingly being used for research on asthma to inform health services and health policy. Validation of the recording of asthma diagnoses in electronic health records is essential to use these databases for credible epidemiological asthma research. Methods We searched EMBASE and MEDLINE databases for studies that validated asthma diagnoses detected in electronic health records up to October 2016. Two reviewers independently assessed the full text against the predetermined inclusion criteria. Key data including author, year, data source, case definitions, reference standard, and validation statistics (including sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were summarized in two tables. Results Thirteen studies met the inclusion criteria. Most studies demonstrated a high validity using at least one case definition (PPV >80%). Ten studies used a manual validation as the reference standard; each had at least one case definition with a PPV of at least 63%, up to 100%. We also found two studies using a second independent database to validate asthma diagnoses. The PPVs of the best performing case definitions ranged from 46% to 58%. We found one study which used a questionnaire as the reference standard to validate a database case definition; the PPV of the case definition algorithm in this study was 89%. Conclusion Attaining high PPVs (>80%) is possible using each of the discussed validation methods. Identifying asthma cases in electronic health records is possible with high sensitivity, specificity or PPV, by combining multiple data sources, or by focusing on specific test measures. Studies testing a range of case definitions show wide variation in the validity of each definition, suggesting this may be important for obtaining asthma definitions with optimal validity.

St George's Respiratory Questionnaire Score Predicts Outcomes in Patients with COPD: Analysis of Individual Patient Data in the COPD Biomarkers Qualification Consortium Database.

Abstract: Background: We aimed to estimate the usefulness of a disease specific health status measure, the St George's Respiratory Questionnaire (SGRQ), to predict outcomes in patients with chronic obstructive pulmonary disease (COPD). Methods: Individual patient-data of 12043 patients from long-term randomized clinical trials (2-4 years' duration) in the COPD Biomarkers Qualification Consortium database were analyzed. The adverse COPD outcomes were: exacerbations of COPD, hospital admissions due to exacerbation and all-cause mortality. Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for quartiles of SGRQ scores at baseline and time to first event, and time from first to second event, where appropriate. Results: The risk of adverse COPD outcomes increased with each increasing quartile of SGRQ score for all time to first event analyses. When comparing the lowest versus the highest quartile, the event risk (HRs [95% CIs]) increased by 40% for exacerbations (1.40 [1.29, 1.51]); 2-fold for hospital admissions (2.01 [1.78, 2.28]) and more than 2-fold for all-cause mortality (2.30 [1.91, 2.78]). For second event analyses in a subset of eligible patients, these trends persisted albeit with reduced risk estimates for exacerbations. Conclusions: Among patients with COPD, health status measured by a SGRQ score predicted exacerbations of COPD, hospital admissions due to exacerbations and their recurrence and death after adjustment. These data support the rationale for a health status measure use as a drug development tool and suggest that a health status measure may also have a role in risk assessment for COPD patients in routine medical care.

Responder Analyses for Treatment Effects in COPD Using the St George's Respiratory Questionnaire.

Abstract: Background: Patient-reported outcomes data in clinical trials are usually reported as mean values, interpreted in comparison to a minimum clinically important difference (MCID) and ignoring the possibility of a sizable proportion of patients experiencing a worthwhile benefit when the majority did not. This analysis tested the reliability of calculated responder rates (from chronic obstructive pulmonary disease [COPD] patients) with the St George's Respiratory Questionnaire (SGRQ) using a range of responder cut-points above and below the MCID (4 units). Methods: Individual patient data (i.e., data from long-acting bronchodilator [LAB] and inhaled corticosteroids [ICS]/long-acting beta2-agonist [LABA] randomized clinical studies) in the COPD Biomarker Qualification Consortium database were used: short-term (≤1-year duration; 14,814 patients,) and medium-term (2-4 years; 12,043 patients). Responder rates versus placebo across SGRQ score change thresholds ranging from -1.5 to -8.0 were tested; differences were expressed as the odds ratio (OR) of a patient exceeding the threshold versus no change or deterioration. Results: The ORs measuring benefit of active treatment were similar across thresholds in short-term studies (LAB, ORs 1.40-1.42; LABA/ICS, 1.50-1.56) and medium-term LAB studies (ORs 1.34-1.43), whereas ORs in medium-term studies with LABA/ICS intervention showed a trend for higher response rates at higher values of threshold cut-points (1.64-1.79). In short-term studies, different thresholds had little effect on the OR between active drugs versus a trend for lower ORs with lower thresholds in medium-term studies. Conclusions: The OR for a treatment effect compared with placebo appears consistent across a range of responder cut-points. In medium-term trials, the treatment difference between active drugs suggests that use of a lower threshold would not increase the odds of observing a measured treatment difference.

Cardiovascular Disease Does Not Predict Exacerbation Rate or Mortality in Chronic Obstructive Pulmonary Disease.

Abstract: Bell NJ, Rainer M, Mt-Isa S, Voase N, et al. Changes in physiological, functional and structural markers of cystic fibrosis lung disease with treatment of a pulmonary exacerbation. Thorax 2013; 68:532–539. 7. Thomen RP, Walkup LL, Roach DJ, Cleveland ZI, Clancy JP, Woods JC. Hyperpolarized 129Xe for investigation of mild cystic fibrosis lung disease in pediatric patients. J Cyst Fibros 2017;16:275–282. 8. Marshall H, Horsley A, Taylor CJ, Smith L, Hughes D, Horn FC, Swift AJ, Parra-Robles J, Hughes PJ, Norquay G, et al. Detection of early subclinical lung disease in children with cystic fibrosis by lung ventilation imaging with hyperpolarised gas MRI. Thorax 2017;72: 760–762. 9. Kanhere N, Couch MJ, Kowalik K, Zanette B, Rayment JH, Manson D, Subbarao P, Ratjen F, Santyr G. Correlation of LCI with hyperpolarized (129)Xe magnetic resonance imaging in pediatric CF subjects. Am J Respir Crit Care Med [online ahead of print] 28 Feb 2017; DOI: 10.1164/rccm.201611-2228LE. 10. Smith L, Aldag I, Hughes P, Horn F, Marshall H, Norquay G, Collier G, Hughes D, Taylor C, Horsley A, et al. Longitudinal monitoring of disease progression in children with mild CF using hyperpolarised gas MRI and LCI. Eur Respir J 2016;48(Suppl 60):OA284. 11. Smith L, Aldag I, Hughes P, Horn F, Marshall H, Norquay G, Collier G, Hughes D, Taylor C, West N, et al. Longitudinal monitoring of disease progression in children with mild CF using 3-helium MRI and LCI. Presented at the North American Cystic Fibrosis Conference. October 27–29, 2016, Orlando, FL. 12. Smith L, Aldag I, Hughes P, Horn F, Marshall H, Norquay G, Collier G, Hughes D, Taylor C, Horsley A, et al. Longitudinal monitoring of disease progression in children with mild cystic fibrosis using hyperpolarised gas MRI and lung clearance index. Presented at the 25th Annual Meeting of the International Society for Magnetic Resonance in Medicine. April 22–27, 2017, Honolulu, HI. 13. Altes TA, Johnson M, Fidler M, Botfield M, Tustison NJ, Leiva-Salinas C, de Lange EE, Froh D, Mugler JP 3rd. Use of hyperpolarized helium-3 MRI to assess response to ivacaftor treatment in patients with cystic fibrosis. J Cyst Fibros 2017;16:267–274.

Validation of asthma recording in electronic health records: protocol for a systematic review.

Abstract: Background Asthma is a common, heterogeneous disease with significant morbidity and mortality worldwide. It can be difficult to define in epidemiological studies using electronic health records as the diagnosis is based on non-specific respiratory symptoms and spirometry, neither of which are routinely registered. Electronic health records can nonetheless be valuable to study the epidemiology, management, healthcare use and control of asthma. For health databases to be useful sources of information, asthma diagnoses should ideally be validated. The primary objectives are to provide an overview of the methods used to validate asthma diagnoses in electronic health records and summarise the results of the validation studies. Methods EMBASE and MEDLINE will be systematically searched for appropriate search terms. The searches will cover all studies in these databases up to October 2016 with no start date and will yield studies that have validated algorithms or codes for the diagnosis of asthma in electronic health records. At least one test validation measure (sensitivity, specificity, positive predictive value, negative predictive value or other) is necessary for inclusion. In addition, we require the validated algorithms to be compared with an external golden standard, such as a manual review, a questionnaire or an independent second database. We will summarise key data including author, year of publication, country, time period, date, data source, population, case characteristics, clinical events, algorithms, gold standard and validation statistics in a uniform table. Ethics and dissemination This study is a synthesis of previously published studies and, therefore, no ethical approval is required. The results will be submitted to a peer-reviewed journal for publication. Results from this systematic review can be used to study outcome research on asthma and can be used to identify case definitions for asthma. PROSPERO registration number CRD42016041798.

The COPD Biomarkers Qualification Consortium Database: Baseline Characteristics of the St George's Respiratory Questionnaire Dataset.

Abstract: The COPD Biomarkers Qualification Consortium (CBQC) is a public-private partnership formed in 2010 with a goal of qualifying biomarkers and clinical assessment tools for use in clinical or nonclinical decision-making and particularly within the regulatory context. The St George's Respiratory Questionnaire (SGRQ) is a measure of health-related quality of life widely used in clinical research. The aim of the CBQC working group on SGRQ was to construct an individual patient level database of clinical trial data that included the SGRQ, to use this to confirm the reliability and validity of the SGRQ as an outcome measure of health status, and investigate its use as a predictor of future events (exacerbations and mortality). This manuscript describes the formulation of the CBQC database and presents the baseline demographic and clinical characteristics of the integrated SGRQ database overall, and by study type (short-term [≤1 year], medium-term [2-4 years] and observational studies). Distribution of baseline SGRQ scores varied little by demographic determinants except for income region in the observational data set (low-middle income countries +10 units compared with high income, p<0.0001) and this observation held across studies. SGRQ scores increased with increasing modified Medical Research Council dyspnea scores (mean differences ranged 6.9-17.9 units) and with increasing airflow limitations (Global initiative for chronic Obstructive Lung Disease grades 1 to 4; differences ranged 4.5-16.1 units), consistent across study types. As a method of cross-sectional comparison, the SGRQ appears to be relatively free of bias from demographic factors although care should be taken when making cross sectional comparisons of scores between patients in countries at different levels of socio-economic development/.

Socioeconomic Status as a Determinant of Health Status Treatment Response in COPD Trials.

Abstract: Background: Randomized controlled trials (RCTs) often recruit patients from low and high socioeconomic status (SES) countries, but little is known about the effect of SES on clinical outcomes, particularly patient-centered measures of symptomatic benefit. Methods: Combined individual chronic obstructive pulmonary disease (COPD) patient data from the placebo and long-acting bronchodilator arms of 17 RCTs (from the COPD Biomarkers Qualification Consortium database) were analyzed. Health status was measured using the St George's Respiratory Questionnaire (SGRQ) (minimum clinically important difference [MCID]: 4 units). Trials were grouped into short-term (≤12 months) and medium-term (>12 months to 48 months). A participant's country of residence was categorized into Low/Medium or High SES using World Health Organization criteria. Results: Data from 19765 individuals (6109 Low/Medium SES) were available. Patients in Low/Medium SES countries had more severe disease at baseline. Improvement in SGRQ score with placebo was ≈2 units greater in Low/Medium than in High SES countries; at its greatest, the improvement from baseline exceeded the MCID in Low/Medium countries. This difference was maintained for at least 1 year. Improvement with bronchodilator was also greater in Low/Medium versus High SES countries; overall there was no evidence that the treatment effect versus placebo was different between countries of different SES status. Conclusions: Participants in Low/Medium SES countries experienced significantly larger treatment effects, irrespective of treatment group (placebo and bronchodilator). Despite this, COPD patients in Low/Medium SES countries experienced a health status gain from long-acting bronchodilator treatment that is similar to that seen in High SES countries.

Bronchodilator reliever use and its association with the economic and humanistic burden of COPD: a propensity-matched study

Abstract: Background and aims: Short-acting bronchodilators are normally used as supplemental relief medication for breakthrough symptoms in COPD patients. The objective of this cross-sectional study was to assess if more frequent vs infrequent use of relief medication in maintenance-treated COPD patients, split by the severity dyspnea, was associated with an increase in the overall disease burden.Methods: A population-based cross-sectional survey (Adelphi DSP) was conducted among patients with COPD in five European countries. Information was collected on demographic and clinical characteristics, reliever inhaler use, dyspnea (mMRC), health status (CAT, EQ-5D), sleep quality (JSEQ) and healthcare resource use including moderate–severe COPD exacerbations, physician visits, COPD medications and other COPD related resources. The humanistic and economic burden was compared between patients with infrequent reliever use (<1 occasion/week) and more frequent use (≥ 1 occasion/week). The association between increase...

Canadian Society of Allergy and Clinical Immunology annual scientific meeting 2016

Abstract: Background: The regulatory assessment of novel food includes tests for allergy. The World Health Organization suggests tests in an animal model of allergy despite the lack of a validated model. We aimed to confirm if C3H/HeJ mice would respond to food of high allergenic potential (peanut), but not to food of low allergenic potential (turkey, potato, spinach). Methods: In the first study, C3H/HeJ mice were orally treated, once per week for two weeks, with adjuvant and 0 or 2 mg of peanut or turkey. A second study used adjuvant and 0, 0.1, 1 or 2 mg of peanut, potato or spinach. Blood IgE antibodies and spleen interleukin-4 were quantified. Results: Mice treated with 2 mg peanut developed peanut-specific IgE levels which were significantly higher than control mice (p<0.001, n=10/ group). Mice treated with 2 mg turkey developed a similar IgE response to turkey (p<0.001, n=10/group). In the second study, allergy was only triggered in one of ten mice treated with 2 mg peanut. Two of ten mice exposed to 1 mg potato had a response. There were no IgE responders to spinach. Spleen cells from both the peanut- and the spinach-treated mice secreted more allergy-promoting interleukin-4 than controls (p<0.01, n=7-24/group). Levels were not modified in potato-treated mice. Conclusions: C3H/HeJ mice developed food allergy markers to peanut. However, the incidence varied between experiments. Some mice developed a similar response to foods with low allergenic potential. Thus, this model may not be appropriate for safety assessment of novel food.

Patient demographics and clinical characteristics in the UK Salford Lung Study (SLS COPD) and the European ACCESS study

Abstract: SLS COPD (NCT01551758) was a 12-month, open-label, randomised controlled trial (RCT) that evaluated the effectiveness and safety of initiating fluticasone furoate/vilanterol 100/25µg vs continuing usual care in COPD patients (pts) with exacerbation (Exa) history (Vestbo et al. NEJM 2016). This was the first effectiveness RCT of its kind in UK primary care with broad inclusion criteria and minimal disruption to routine clinical care. The non-interventional ACCESS study (NCT01516528) examined the rate of mod/sev COPD Exa in primary care pts in 6 European countries (GSK Study 115058). The current study describes similarities and differences between SLS COPD and ACCESS datasets. Demographics/clinical characteristics of SLS COPD and ACCESS pts were recorded either at study screening or after randomisation. SLS COPD entry criteria included ≥1 Exa in the preceding 3 yrs. Pt demographics and clinical characteristics in SLS COPD and ACCESS are shown (Table). SLS COPD pts had a higher Exa rate and higher CAT scores than ACCESS pts. Other variables were broadly similar between SLS COPD and ACCESS, and across countries. SLS COPD pts were more severely impacted than ACCESS pts, possibly due to the Exa history inclusion criterion. Otherwise, pt characteristics were largely similar between the UK SLS COPD study and the European countries in the ACCESS population. Funding by GSK: studies 115151 and 115058.

French data from the Continuing to Confront COPD (C2C) survey

Abstract: Resume Introduction Cet article rapporte les donnees francaises de l’enquete Continuing to confront COPD (C2C) menee en 2013 dans 12 pays. Son objectif etait de decrire les caracteristiques, symptomes et impact global de la bronchopneumopathie chronique obstructive (BPCO) sur l’etat de sante, les activites quotidiennes et professionnelles chez des adultes rapportant soit un diagnostic de BPCO, d’emphyseme ou de bronchite chronique, soit des symptomes de bronchite chronique, presents ou pour lesquels ils etaient traites (« repondants BPCO »). Methodes Des adultes âges de 40 ans ou plus ont ete selectionnes selon une enquete telephonique a composition aleatoire. Les repondants BPCO etaient invites a completer l’enquete. Resultats La proportion de repondants BPCO a ete estimee a 7,5 %. Parmi 300 repondants BPCO, 48 % etaient des hommes, 44 % âges de plus de 70 ans, 45 % en surpoids et 72 % avaient des antecedents de tabagisme. La BPCO avait un impact severe/tres severe (COPD assessement test > 20) sur la sante pour 43 % ; 70 % rapportaient une dyspnee (mMRC ≥ 1) et 65 % une limitation dans plus de 20 % de leurs activites quotidiennes. Le nombre moyen d’exacerbations etait de 2/an et 16 % des patients avaient ete hospitalises pour motif respiratoire dans l’annee ecoulee. Pourtant, 80 % consideraient leur maladie moderement severe. Conclusion L’impact de la BPCO reste sous-estime malgre un retentissement important en termes de symptomes, d’etat de sante et d’exacerbations.

Baseline Severity as Predictor of Change in St George's Respiratory Questionnaire Scores in Trials of Long-acting Bronchodilators with COPD Patients.

Abstract: Background: In trials oflong-acting bronchodilators, health status is an important trial outcome, however the influence of baseline severity on response measured by St George's Respiratory Questionnaire (SGRQ) is not known. We have compared SGRQ changes between patients with chronic obstructive pulmonary disease (COPD) of mild-moderate severity or dyspnea (Global initiative for chronic Obstructive Lung disease [GOLD] grades 1 and 2; modified Medical Research Council [mMRC] grades 1 and 2) to those with severe-very severe severity or dyspnea (GOLD grades 3 and 4; mMRC grades 3 and 4). Methods: Combined individual patient data from the COPD Biomarkers Qualification Consortium database (trials of long-acting bronchodilators) were used comprising of patients from short-term (≤1-year duration; n=10802) and medium-term (2-4 years' duration; n=8963) studies. A repeated measures analysis of variance (ANOVA) was used to determine the effects of baseline severity (GOLD/mMRC) on SGRQ response to treatment. All treatment arms were combined. Results: In short-term studies, milder patients showed a greater response than those with more severe disease in terms of GOLD grade (partial Eta2 = 0.03, p < 0.0001) and mMRC grade (partial Eta2 = 0.05, p < 0.0001). Similar results were seen in the medium-term studies (partial Eta2 = 0.02, p < 0.0001; mMRC: partial Eta2 = 0.05, p < 0.0001,). Conclusions: Patients with less severe airflow limitation and less severe dyspnea showed larger improvements in SGRQ score than more severely obstructed or dyspneic patients. Although these severity influences are small (2%-5% of the variance in SGRQ score), they do suggest that pre-specified separate analyses are warranted to test for differences in response, based on baseline severity.

P96 Death related to cardiovascular disease in chronic obstructive pulmonary disease

Abstract: Chronic obstructive pulmonary disease (COPD) kills over 5.6% (3.2 million) of the world population every year and is projected to increase to 7.8% by 2030. According to the literature about a third of patients with COPD die of cardiovascular disease (CVD). However, these findings do not match clinical data from the Evaluating the Role of Inflammation in Chronic Airways disease (ERICA) cohort − a multi-centre observational cohort study of 729 patients with COPD − nor published data from the late 60 s indicating only about a tenth of patients dying of CVD. The aim of our study was to categorise causes of death, and compare self-reported CVD incidence with electronic health records. Clinical data were linked to mortality data from the Office for National Statistics. Causes of death were categorised by cardiovascular and respiratory physicians. Self-reported cardiovascular events were compared with hospital episode statistics. Results indicate that after 5 years of follow-up, a majority of deaths (n=119) are due to pulmonary causes (53%), followed by cancer (24%) with fewer cases than expected having a cardiac cause of death (14%). Eight per cent died of other causes. In addition, there were only few severe cardiovascular events such as stroke and heart attack. It might be that globally the cause of death within COPD has changed over several decades with increased numbers of cardiac causes of deaths but our findings do not indicate as many cardiac deaths and this trend might at least exclude the UK and warrants further exploration.