Background: Not all chronic diseases have clear pathways and time targets for diagnosis. We explored pathways and timings for four major chronic respiratory diseases in England.
Methods: Using de-identified electronic healthcare records from Clinical Practice Research Datalink Aurum linked to Hospital Episode Statistics, we derived cohorts of patients diagnosed with asthma, COPD, ILD or bronchiectasis at three time periods (2008/9, 2018/9, and 2020/1). We followed people two years before and two years after diagnosis, calculating the proportion of people who presented with symptoms, underwent diagnostic tests, were treated, and consulted healthcare (primary or secondary); and calculated time intervals between events. We repeated analyses by socioeconomic status and geographical region.
Results: We descriptively studied patient pathways for 429,619 individuals across all timeframes and diseases. Most people (>87%) had first evidence of diagnosis in primary care. The proportion of people reporting symptoms prior to diagnosis was similar for asthma, COPD, and ILD (41.0-57.9%), and higher in bronchiectasis (67.9-71.8%). The proportion undergoing diagnostic tests was high for COPD and bronchiectasis (77.6-89.2%), and lower for asthma (14-32.7%) and ILD (2.6-3.3%). The proportion of people undergoing diagnostic tests decreased in 2020/1 for all diseases, mostly COPD. Time (months) (median [interquartile range]) between symptoms to diagnosis, averaged over three time periods, was lowest in asthma (~7.5 [1.3, 16.0]), followed by COPD (~8.6 [1.8, 17.2]), ILD (~10.1 [3.6, 18.0]), and bronchiectasis (~13.5 [5.9, 19.8]). Time from symptoms to diagnosis increased by ~two months in asthma and COPD over the three time periods. Although most patients were symptomatically treated prior to diagnosis, time between diagnosis and post-diagnostic treatment was around four months for ILD, three months for bronchiectasis, and instantaneous for asthma and COPD. Socioeconomic status and regional trends showed little disparity.
Conclusion: Current pathways demonstrate missed opportunities to diagnose and manage disease, and to improve disease coding.