Blood eosinophil count may be a useful biomarker for predicting response to inhaled corticosteroids and exacerbation risk in chronic obstructive pulmonary disease (COPD) patients. The optimal cut point for categorizing blood eosinophil counts in these contexts remains unclear. We aimed to determine the distribution of blood eosinophil count in COPD patients and matched non-COPD controls, and to describe demographic and clinical characteristics at different cut points. We identified COPD patients within the UK Clinical Practice Research Database aged ≥40 years with a FEV/FVC <0.7, and ≥1 blood eosinophil count recorded during stable disease between January 1, 2010 and December 31, 2012. COPD patients were matched on age, sex, and smoking status to non-COPD controls. Using all blood eosinophil counts recorded during a 12-month period, COPD patients were categorized as "always above," "fluctuating above and below," and "never above" cut points of 100, 150, and 300 cells/μL. The geometric mean blood eosinophil count was statistically significantly higher in COPD patients versus matched controls (196.6 cells/µL vs. 182.1 cells/µL; mean difference 8%, 95% CI: 6.8, 9.2), and in COPD patients with versus without a history of asthma (205.0 cells/µL vs. 192.2 cells/µL; mean difference 6.7%, 95%, CI: 4.9, 8.5). About half of COPD patients had all blood eosinophil counts above 150 cells/μL; this persistent higher eosinophil phenotype was associated with being male, higher body mass index, and history of asthma. In conclusion, COPD patients demonstrated higher blood eosinophil count than non-COPD controls, although there was substantial overlap in the distributions. COPD patients with a history of asthma had significantly higher blood eosinophil count versus those without.

This retrospective cohort study aimed to assess treatment patterns over 24 months amongst patients with chronic obstructive pulmonary disease (COPD), initiating a new COPD maintenance treatment, and to understand clinical indicators of treatment change. Patients included in the study initiated a long-acting β-agonist (LABA), a long-acting muscarinic antagonist (LAMA), or a combination of LABA and an inhaled corticosteroid (ICS/LABA) between January 1, 2009, and November 30, 2013, as recorded in the United Kingdom Clinical Practice Research Datalink (UK CPRD). Treatment modifications (switching or adding maintenance treatments) over 24 months were assessed, and patient characteristics, disease burden, medication and healthcare resource use during the 30 days before treatment modification were evaluated. The cohort comprised 17,258 patients [LABA (8%), LAMA (39%) and ICS/LABA (54%)] with similar age, body mass index and dyspnoea distribution. LABA users were more likely than LAMA users to add a maintenance therapy. Distinct patterns of treatment augmentations were noted, whereby LABA users typically received dual therapy before moving to triple therapy, while LAMA users moved to triple therapy by directly adding an ICS/LABA. Exacerbation events immediately prior to treatment change were not frequently recorded; however, the need for rescue short-acting medication and assessment of dyspnoea in the 30 days prior to the treatment change suggest that dyspnoea is a remaining unmet need driving therapy change.

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AimTo characterise disease burden, health care resource utilisation (HCRU), and costs among a cohort of COPD patients newly prescribed maintenance therapy in UK general practice.MethodA retrospective cohort of COPD patients aged ≥40 yrs and newly prescribed COPD monotherapy (long acting beta-agonists [LABA] or long acting muscarinic antagonist [LAMA]), dual therapy (LABA+LAMA; LABA+inhaled corticosteroid (ICS); LAMA+ICS) or open triple therapy (LAMA+LABA+ICS) between 1/1/2009 and 30/11/2012 was identified from UK Clinical Practice Research Datalink (CPRD).Health care resource utilisation assessed in the 12 months prior to maintenance therapy initiation included moderate (community treated) and severe (hospital or A&E treated) COPD exacerbations (rate per 100 person years [PY]), general practice (GP) interactions, other COPD treatments, and non-COPD related hospitalisations. The costs associated with HCRU were calculated using National Health Services reference costs for 2013–14 and PSSRU costs for 2014.ResultsA total of 39,639 COPD patients were included (54% male, mean age 68 yrs (SD: 11)). LABA+ICS (39%) and LAMA (34%) were the most commonly initiated LABD; 13% were first exposed to LABD as part of an open triple regimen (Table 1). Patients initiating an ICS-containing regimen had a higher exacerbation rate (moderate or severe) in the 12 months prior to maintenance therapy initiation (LABA+ICS: 0.74 per PY [95% CI:0.72–0.75]; LAMA+ICS: 0.86 per PY [0.82–0.90] and LAMA+LABA+ICS: 0.83 per PY [0.80–0.85]) compared to patients on bronchodilators alone (LAMA: 0.55 per PY [0.54–0.57]; LABA: 0.56 per PY [0.54–0.59]; LAMA+LABA: 0.50 per PY [0.44–0.56]). Patients on open triple therapy demonstrated the highest rates of non-COPD related hospitalisations. The annual per patient cost ranged from £2,139 (LABA) to £2,876 (LAMA+LABA+ICS); approximately half were due to GP visits and a third resulted from non-COPD related hospitalisations (Table 1).Abstract P132 Table 1Annual per patient health care utilisation costs 12 months prior to LABD initiationLABA(N = 2899)LAMA(N = 13511)LABA+LAMA(N = 525)LABA+ICS(N = 15374)LAMA+ICS(N = 2370)LAMA+LABA+ICS(N = 4960)Total costs£2,139£2,223£2,240£2,334£2,410£2,876GP visits£1,230£1,249£1,237£1,224£1,313£1,272All exacerbations£173£192£179£247£287£400Non-COPD hospitalisations£709£759£795£811£703£1,159Treatment£27£23£29£51£106£46ConclusionPatients with a higher baseline exacerbation rate were more likely to receive ICS- containing therapies compared to those taking bronchodilators alone. Across all maintenance therapy groups, GP visits and non-COPD related hospitalisations were the primary driver of total costs.