Disease Burden and Healthcare Utilization Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in England

Abstract

Clinical guidelines for COPD management suggest pharmacologic treatment algorithms based on symptoms and exacerbation history. As previous research has suggested that prescribing patterns are not always aligned with these recommendations, this study investigated the burden of disease in patients with COPD receiving, and persisting on, new inhaled maintenance therapy. Patients and Methods: This was a retrospective observational study using two linked electronic databases containing health records of patients in England. Patients aged ≥35 years with a confirmed diagnosis of COPD, and who initiated a new inhaled respiratory pharmacologic maintenance regimen between January 1, 2014 and December 31, 2016 (index date) were eligible for inclusion. New treatments could be long-acting muscarinic antagonist (LAMA) or long-acting β 2 -agonist (LABA) monotherapy, inhaled corticosteroid (ICS)/LABA or LAMA/LABA dual therapy, or a multiple-inhaler triple therapy (MITT; LAMA/LABA/ICS). Patients were required to have 12 months of available medical history prior to, and after, the index date. Results: In total, 25,350 eligible patients were identified, of these 8282 (mean age: 70.9 years; 51.5% male) persisted with their newly prescribed inhaled therapy for ≥12 months and were included in the analysis. In the 12 months prior to index, 54% of patients had moderate or severe dyspnea (Medical Research Council score ≥3). The most common therapy initiated at index was MITT (42%), followed by ICS/LABA dual therapy (31.2%). The proportion of patients with moderate or severe dyspnea in the post-index period ranged from 29.0% of patients receiving ICS to 64.2% of patients receiving MITT. In the post-index period, 48.1% of patients experienced ≥1 exacerbation and 54.9% had ≥5 general practitioner visits. Conclusion: Many of the patients with COPD in our study continued to experience symptoms and exacerbations, despite persisting on the same treatment for ≥12 months. This suggests that some patients may benefit from treatment modification in accordance with guideline recommendations.

Cross-sectional analyses of online appointment booking and repeat prescription ordering user characteristics in general practices of England in the years 2018–2020

“…The adoption of online services by those with long-term conditions is promising and can potentially contribute to improving self-management of long-term conditions 2. However, there is evidence that people with long-term conditions may generally be more likely to use healthcare services 44–46. Practices should continue to encourage and support people with long-term conditions to sign up and use online services.…”

“…Practices should continue to encourage and support people with long-term conditions to sign up and use online services. However, it is essential that alternatives to online services continue to be provided to people who are unwilling or unable to use these services 44–46…”

Smad7 ameliorate small airway remodeling in COPD by modulating epithelial-mesenchymal transition

“…The aspects of small airway remodeling are epithelial mucous metaplasia, lung parenchyma destruction, collagen deposition and brosis of airway wall, etc., of which the mechanisms remain largely unknown [6]. At present, the mainstay drug therapies for COPD are bronchodilators, inhaled corticosteroids, etc [7]. whose suppressive effect on airway remodeling are not yet con rmed [8].…”

A Randomized Phase I Study of the Anti‐Interleukin‐33 Antibody Tozorakimab in Healthy Adults and Patients With Chronic Obstructive Pulmonary Disease

“…Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide 1,2 . Many patients with COPD continue to experience exacerbations despite receiving standard of care therapies 3–5 . Hence, there is an urgent need to develop new therapies to prevent COPD exacerbations and thereby improve patient outcomes.…”