Patients With Intellectual Disabilities Face Distinct Challenges in COPD, Asthma Care

Compared to those without intellectual disabilities, patients with intellectual disabilities experienced inconsistent chronic obstructive pulmonary disease (COPD) consultations and higher rates of antibiotic prescriptions for asthma, according to a study published in npj Primary Care Respiratory Medicine.¹

People with intellectual disabilities, who have significant limitations in both intellectual functioning and adaptive behavior, have poorer health than the general public.² Therefore, patients with intellectual disabilities experience higher rates of chronic conditions and shorter life expectancy; these rates also apply to pulmonary conditions.¹

The researchers noted that adequate management of COPD and asthma in patients with intellectual disabilities by general practitioners (GPs) is difficult, resulting in poor health outcomes. Past research found that, in the last year of life, patients with intellectual disabilities had increased odds of hospitalization and death from respiratory disorders.³ Therefore, asthma and COPD both have a significant impact on patients’ quality of life, which will be exacerbated if GP care is not adequately coordinated.¹

However, specific information on how GPs manage the diseases in patients with intellectual disabilities is scarce. Consequently, the researchers conducted a study to examine the potential differences in GP disease management delivery among adult patients with COPD or asthma and intellectual disabilities compared with patients without intellectual disabilities.

Patients with intellectual disabilities experience inconsistent chronic obstructive pulmonary disease (COPD) consultations and higher rates of antibiotic prescriptions for asthma. | Image Credit: bongkarn - stock.adobe.com

To do so, they utilized the GP database of the Department of Primary and Community Care at the Radboud University Medical Centre in the Netherlands, which covers about 100 general practices with more than 450,000 patients; the researchers used data from 79 of these practices, spanning 2010 to 2019.

The researchers included all adult patients with either COPD or asthma in their study population, which they identified using the International Classification of Primary Care (ICPC) codes. Similarly, they used diagnostic ICPC codes in combination with intellectual disability-related text entries to identify patients with intellectual disabilities. The researchers collected various data from the database, including patient characteristics, consultation patterns, comorbidities, prescribed medications, and smoking status.

Initially, the study population consisted of 15,320 adult patients with asthma but without intellectual disabilities, 157 patients with both asthma and intellectual disabilities, 9058 patients with COPD but without intellectual disabilities, and 71 patients with both COPD and intellectual disabilities. Using the cohort of patients without intellectual disabilities, the researchers created a control group with a 1:2 ratio for GP practice, age, sex, asthma or COPD diagnosis, and a diagnosis before or after January 1, 2019.

After matching, they analyzed 156 patients with asthma and intellectual disabilities, 312 patients with asthma but without intellectual disabilities, 68 patients with COPD and intellectual disabilities, and 133 patients with COPD but without intellectual disabilities.

Among patients with asthma but without intellectual disabilities, the year-point prevalence rose from 4.2% in 2010 to 6.0% in 2019; for patients with asthma and intellectual disabilities, it increased from 4.1% in 2010 to 8.7 in 2019. Therefore, from 2014 onwards, the asthma year-point prevalence was significantly higher in patients with intellectual disabilities than in those without intellectual disabilities. However, the COPD year-point prevalence was comparable in patients with and without intellectual disabilities.

Current smoking rates were significantly higher in patients with intellectual disabilities in both the asthma (45.2% vs 22.1%; P = .001) and COPD (76.6% vs 51.4%; P = .014) cohorts. Similarly, more patients with asthma and intellectual disabilities were obese compared to their matched peers (53.2% vs 39.5%; P = .03); they also were more frequently diagnosed with diabetes (14.7% vs 8.3%; P = .03), along with anxiety and/or depression (34.5% vs 21.8%; P = .003).

As for delivered care, there was no statistical difference regarding the number and type of consultations among patients in the asthma cohort. However, inconsistencies existed in the COPD cohort, as patients with intellectual disabilities received either no COPD-related practice consultations (20.8% vs 8.5%; P = .004) or many practice consultations (16.7% vs 5.3%; P = .004) compared with patients without intellectual disabilities.

Lastly, in terms of prescribed medications, significantly more patients with asthma and intellectual disabilities were prescribed a long-acting β agonist combined with an inhaled corticosteroid (LABA/ICS) compared with those without intellectual disabilities (46.8% vs 36.5%; P = .03). Also, a larger portion of patients with asthma and intellectual disabilities were prescribed oral antibiotics (69.9% vs 54.5%; P = .001). Conversely, in the COPD cohort, LABA was prescribed to a significantly lower number of patients with intellectual disabilities compared to those without intellectual disabilities (13.2% vs 25.6%; P = .04).

The researchers acknowledged study limitations, one being that the data only included patients with intellectual disabilities who found their way to a GP and received a diagnosis. Because it is challenging for patients with intellectual disabilities to access primary health care and receive adequate diagnoses, they noted that their findings may have underestimated the actual primary care practice situation. Based on their findings, the researchers suggested areas for further research.

"...our results warrant further research into the causes of the differences found and whether they also infer differences in the quality or the effectiveness of asthma and COPD care for people with intellectual disabilities, especially for young adults with intellectual disabilities," the authors concluded.

References

1. Mastebroek M, Everlo NCM, Cuypers M, Bischoff EWMA, Schalk BWM. Asthma and COPD management of patients with intellectual disabilities in general practice. NPJ Prim Care Respir Med. Published online June 25, 2024. doi:10.1038/s41533-024-00375-w
2. Harris JC. New classification for neurodevelopmental disorders in DSM-5. Curr Opin Psychiatry. 2014;27(2):95-97. doi:10.1097/YCO.0000000000000042
3. Brameld K, Spilsbury K, Rosenwax L, Leonard H, Semmens J. Use of health services in the last year of life and cause of death in people with intellectual disability: a retrospective matched cohort study. BMJ Open. 2018;8(2):e020268. doi:10.1136/bmjopen-2017-020268