Symptomatic burden of COPD for patients receiving dual or triple therapy

Chen, Stephanie; Small, Mark; Bailey, Tom; Lindner, Leandro; Xu, Xiao

doi:10.1183/1393003.congress-2017.pa3246

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…As the severity of dyspnoea increases, the patients become dependent over time (8,12). Dyspnoea causes patients with COPD to unconsciously reduce their daily life activities in order to relax (13), negatively affects the quality of their lives (14) and contributes to development of disability (15,16). Cil Akinci and Pinar in their study on 72 patients with COPD found that the patients had difficulty in performing daily life activities, especially instrumental ones, and that the patients with dyspnoea became more dependent in terms of instrumental daily life activities (17).…”

Section: Introductionmentioning

confidence: 99%

The relation between self‐efficacy in patients with chronic obstructive pulmonary disease and caregiver burden

Kar

Zengin

2019

Scandinavian Caring Sciences

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Aim The study was conducted to examine the relation between self‐efficacy in patients with chronic obstructive pulmonary disease (COPD) and caregiver burden. Material and methods This descriptive, cross‐sectional study included 200 patients with stage II and III COPD presenting to hospital between June and November in 2017 and their caregivers. Data were gathered with a questionnaire, COPD Assessment Test and COPD Self‐Efficacy Scale from the patients. A questionnaire and Caregiver Burden Scale was used to collect data from the caregivers. Obtained data were analysed with the descriptive statistics numbers, percentages, mean, median and standard deviation. Spearman’s correlation analysis was utilised to examine the relation between paired groups. Results The mean age of the patients with COPD was 63.53 years and 51.1% of the patients were female. The mean age of the caregivers was 48.88 ± 14.09 years. 54.4% of the caregivers were aged 40–60 years, and 59.9% of the caregivers were female. The mean score was 26.97 ± 5.25 for COPD Assessment Test and 2.32 ± 0.43 for COPD Self‐Efficacy Scale. Of all the caregivers, 64.8% had mild caregiving burden and 18.1% had moderate caregiving burden. The mean score for Caregiver Burden Scale had a significant, moderate relation with the mean score for the subscale physical effort in COPD Self‐Efficacy Scale (r = −0.42; p < 0.01) and had a significant, weak, negative relation with the mean total score for COPD Self‐Efficacy Scale and the mean scores for its subscales. There was a significant, moderate, positive relation between the mean scores for Caregiver Burden and COPD Assessment Test (r = 0.51; p < 0.001) and a significant, negative relation between the scores for COPD Self‐Efficacy Scale and its subscales and the scores for CAT (r = −0.26 ‐ r = −0.52; p < 0.05). Conclusion As self‐efficacy in COPD patients increases, their health and daily lives are affected less by COPD and caregiver burden decreases.

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Section: Introductionmentioning

confidence: 99%

The relation between self‐efficacy in patients with chronic obstructive pulmonary disease and caregiver burden

Kar

Zengin

2019

Scandinavian Caring Sciences

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“…Despite receiving dual or triple inhaled combination therapy (two or three of the following types of agents: inhaled glucocorticoids, longacting β 2 -agonists [LABAs], and long-acting muscarinic antagonists [LAMAs]), patients with COPD may continue to have exacerbations. 4,5 As many as 40% of patients with stable COPD may have eosinophilic inflammation, which is associated with an increased risk of exacerbations as well as glucocorticoid responsiveness. 6,7 Some studies have shown that elevated blood eosinophil counts are associated with an increased risk of exacerbations and that inhaled glucocorticoids are efficacious in preventing exacerbations in this population.…”

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confidence: 99%

Benralizumab for the Prevention of COPD Exacerbations

et al. 2019

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T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med nejm.org 1 The authors' full names, academic degrees, and affiliations are listed in the Appendix. Address reprint requests to Dr. BACKGROUNDThe efficacy and safety of benralizumab, an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody, for the prevention of exacerbations in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) are not known. METHODSIn the GALATHEA and TERRANOVA trials, we enrolled patients with COPD (at a ratio of approximately 2:1 on the basis of eosinophil count [≥220 per cubic millimeter vs. <220 per cubic millimeter]) who had frequent exacerbations despite receiving guideline-based inhaled treatment. Patients were randomly assigned to receive benralizumab (30 or 100 mg in GALATHEA; 10, 30, or 100 mg in TERRANOVA) every 8 weeks (every 4 weeks for the first three doses) or placebo. The primary end point was the treatment effect of benralizumab, measured as the annualized COPD exacerbation rate ratio (benralizumab vs. placebo) at week 56 in patients with baseline blood eosinophil counts of 220 per cubic millimeter or greater. Safety was also assessed. RESULTSIn GALATHEA, the estimates of the annualized exacerbation rate were 1.19 per year (95% confidence interval [CI], 1.04 to 1.36) in the 30-mg benralizumab group, 1.03 per year (95% CI, 0.90 to 1.19) in the 100-mg benralizumab group, and 1.24 per year (95% CI, 1.08 to 1.42) in the placebo group; the rate ratio as compared with placebo was 0.96 for 30 mg of benralizumab (P = 0.65) and 0.83 for 100 mg of benralizumab (P = 0.05). In TERRANOVA, the estimates of the annualized exacerbation rate for 10 mg, 30 mg, and 100 mg of benralizumab and for placebo were 0.99 per year (95% CI, 0.87 to 1.13), 1.21 per year (95% CI, 1.08 to 1.37), 1.09 per year (95% CI, 0.96 to 1.23), and 1.17 per year (95% CI, 1.04 to 1.32), respectively; the corresponding rate ratios were 0.85 (P = 0.06), 1.04 (P = 0.66), and 0.93 (P = 0.40). At 56 weeks, none of the annualized COPD exacerbation rate ratios for any dose of benralizumab as compared with placebo reached significance in either trial. Types and frequencies of adverse events were similar with benralizumab and placebo. CONCLUSIONSAdd-on benralizumab was not associated with a lower annualized rate of COPD exacerbations than placebo among patients with moderate to very severe COPD, a history of frequent moderate or severe exacerbations, and blood eosinophil counts of 220 per cubic millimeter or greater (Funded by AstraZeneca [GALATHEA and TERRANOVA] and Kyowa Hakko Kirin [GALATHEA]; GALATHEA and TERRANOVA ClinicalTrials.gov numbers, NCT02138916 and NCT02155660.)A BS TR AC T

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“…6,8 Maximal inhaled therapy (also called "triple therapy"), which comprises an inhaled corticosteroid (ICS), a long-acting muscarinic antagonist (LAMA), and a long-acting β 2 agonist (LABA), has resulted in decreased moderate or severe COPD exacerbations and a lower rate of COPD-related hospitalizations. [9][10][11] Still, some patients receiving triple therapy may continue to experience frequent exacerbations, 12 some of which have been associated with eosinophilic inflammation with high blood eosinophil counts (BEC). 4,13,14 These patients represent a relevant unmet need that accounts for high health care resource utilization (HCRU).…”

Section: Introductionmentioning

confidence: 99%

Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy

Chen¹,

Miravitlles²,

Rhee³

et al. 2022

COPD

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Background Some patients with chronic obstructive pulmonary disease (COPD) experience frequent exacerbations despite maximal inhaled therapy (“triple therapy”), possibly leading to high health care resource utilization (HCRU). Aim Describe characteristics, future HCRU, and mortality of patients with COPD who experience frequent exacerbations despite triple therapy; characterize individuals who may be candidates for biologic therapies. Methods This descriptive observational study used primary care data of patients aged ≥40 years in the United Kingdom receiving maintenance therapy for COPD who had ≥1 year of data prior to index date and ≥1 year of follow-up data. We described these patients’ clinical and demographic characteristics, including blood eosinophil counts (BEC), pattern of exacerbations, hospitalizations, and corticosteroid exposure, as well as future exacerbations, hospitalizations, and death. Results Of 43,753 patients with maintenance-treated COPD, 6480 experienced exacerbations despite ≥3 months of triple therapy. Of these, 5669 had available BEC: 1287 (22.7%) had BEC ≥250 cells/µL and ≥3 exacerbations in the year prior to the index date; 471 (36.6%) received ≥4 acute courses of oral corticosteroids. Patients with a pattern of high disease burden continued to have high disease burden: 51.1% experienced ≥3 exacerbations and 2.6% experienced ≥3 hospitalizations. Patients who experienced exacerbations despite triple therapy had a significantly higher risk of COPD-related death than other maintenance-treated patients (5.8% vs 2.1%). Conclusion Nearly one-quarter of patients receiving triple therapy for COPD who experienced frequent exacerbations had elevated BEC and ≥3 exacerbations, suggesting a potential mechanism of persistent eosinophilic inflammation that could be a target for eosinophil-depleting biologic therapy.

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Symptomatic burden of COPD for patients receiving dual or triple therapy

Cited by 6 publications

References 12 publications

The relation between self‐efficacy in patients with chronic obstructive pulmonary disease and caregiver burden

The relation between self‐efficacy in patients with chronic obstructive pulmonary disease and caregiver burden

Benralizumab for the Prevention of COPD Exacerbations

Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy

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