The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK

Abstract

BackgroundThis study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burden, measured by health care utilization.MethodsData were extracted from the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients’ rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.ResultsA cohort of 8,811 COPD patients (95% Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45% of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).ConclusionThe average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids.

Patient-Reported Burden of Illness in a Prevalent COPD Population Treated with Long-Acting Muscarinic Antagonist Monotherapy: A Claims-Linked Patient Survey Study

“…In this claims-linked survey study assessing patient-reported symptoms and burden of illness among patients with COPD treated with LAMA monotherapy, COPD had a considerable impact on patient well-being and was associated with substantial resource burden. These results are consistent with observations from previous studies which have reported that patients receiving long-acting bronchodilator monotherapy continued to experience a high symptom burden, had recent exacerbations and exhibited poor QoL, and had a higher than average rate of physician interactions [9,24]. The majority of patients in this study experienced substantial symptom burden as measured by multiple PROs; in particular, there were high levels of dyspnea, with almost half of the patients experiencing severe dyspnea using the definitions presented in the GOLD strategic report [2].…”

Use of medicines and health services for chronic obstructive pulmonary disease among a cohort of Australians over 50 years

“…Our findings are comparable to a 2016 study conducted in the UK (n=8,811 COPD patients) where 10% of patients experienced a COPD exacerbation and 2% were hospitalized for COPD. 22 …”

Regarding: Dual versus single long‐acting bronchodilator use could raise acute coronary syndrome risk by over 50%

“…Furthermore, even using only the history of exacerbations, very severe COPD is two times more frequent in patients treated with LABA+LAMA versus LAMA (7.9% vs. 3.2%). A feasible explanation for this is that patients with noncontrolled disease (including persistent exacerbations) more frequently receive LABA‐LAMA therapy [6].…”