The Heterogeneity of COPD Patients in a Community-Based Practice and the Inadequacy of the Global Initiative for Chronic Obstructive Lung Disease Criteria: A Real-World Experience

Alabi, Fortune O.; Alkhateeb, Hadaya A.; DeBarros, Kayla M.; Benel, Pierina S. Barletti; Sanchez-Martez, Rachel L.; Zeper, Mia L.; Ismail, Reema A.; Umeh, Fred; Medina-Villanueva, Nelson

doi:10.15326/jcopdf.2021.0229

Cited by 13 publications

(14 citation statements)

References 29 publications

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“…As lung function data were not available in the MarketScan ® database, it is not possible to know what proportion of US patients had a diagnosis of COPD based on airflow obstruction (FEV 1 /FVC < 70%, as per the GOLD criteria). In a previous US study conducted in a community-based practice, only 43% of patients met the GOLD criterion for airflow obstruction [ 34 ]. This might partly explain the high use of LABA/ICS observed in our US dataset because, in the absence of pulmonary function data, physicians may be more inclined to prescribe ICS due to uncertainty around a potential diagnosis of asthma.…”

Section: Discussionmentioning

confidence: 99%

First Maintenance Therapy for Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

et al. 2022

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Introduction: Inhaled corticosteroids (ICS) are often prescribed inappropriately alongside longacting bronchodilators for chronic obstructive pulmonary disease (COPD). We aimed to investigate if prescribing habits in the US and UK differ from recommendations for initiation of COPD maintenance therapy. Methods: We used healthcare data from the US IBM Ò MarketScan Ò and UK Clinical Practice Research Datalink databases to assess exacerbations and comorbidities in patients with COPD initiating first maintenance therapy (1MT) between 2015 and 2018. Patients with a recorded asthma diagnosis prior to initiation of 1MT were excluded. We evaluated time from recorded diagnosis of COPD until initiation of 1MT, and treatment regimen at 1MT (long-acting muscarinic antagonist [LAMA], long-acting b 2agonist [LABA], ICS, as monotherapy or in combination). Results: In the US and UK, median (IQR) time between recorded COPD diagnosis and 1MT was 158 (12; 839) and 29 (1; 521) days, respectively. Among the 53,473 US patients and 8786 UK patients who initiated 1MT, 50.9% and 32.4% had C 1 exacerbation in the previous year. In the US, 20% of patients initiated LAMA, 1% LABA, 13% LAMA/LABA, and 66% an ICS-containing regimen (49% LABA/ICS, 13% ICS, and 4% LAMA/LABA/ICS). In the UK, 53% of patients initiated LAMA, 4% LABA, 16% LAMA/ LABA, and 27% an ICS-containing regimen (14% LABA/ICS, 9% ICS, and 4% LAMA/LABA/ ICS). Conclusions: At 1MT, two-thirds of patients in the US received ICS-containing therapies, with almost half on LABA/ICS. In contrast, less than one-third received ICS-containing therapy in the UK and more than half of patients received LAMA. In both countries, more patients received ICS-containing therapies at initiation of 1MT than would be expected based on their exacerbation history, suggesting overprescribing.

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Section: Discussionmentioning

confidence: 99%

First Maintenance Therapy for Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

et al. 2022

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“…Integrating these datasets enabled the identification of the impact of spatially constrained COPD-associated eQTLs on genes and biological pathways that link to co-occuring conditions. Indeed it is possible that the ‘total’ genetic burden we identified can be used to stratify COPD and it’s multiple clinical presentations, which have previously led to questions about the validity of classifying it as a single diagnostic category (Alabi et al 2021; Corlateanu et al 2020; Sakornsakolpat et al 2019). However, this study also has several limitations.…”

Section: Discussionmentioning

confidence: 99%

De novo discovery of traits co-occurring with chronic obstructive pulmonary disease

O’Sullivan

Fadason

Jaros

et al. 2022

Preprint

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Epidemiological research indicates that chronic obstructive pulmonary disease (COPD) is a heterogeneous group of chronic lung conditions that are typically accompanied by cardiovascular disease, depression, lung cancer and other conditions. Genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNPs) associated with COPD and the co-occuring conditions, suggesting common biological mechanisms underlying COPD and these co-occuring conditions. To identify them, we have integrated information across different biological levels (i.e. genetic variants, lung-specific 3D genome structure, gene expression and protein-protein interactions) to build lung-specific gene regulatory and protein-protein interaction networks. We have queried these networks using disease-associated SNPs for COPD, unipolar depression and coronary artery disease. Our results show that COPD-associated SNPs can control genes involved in the regulation of lung or pulmonary function, asthma, brain region volumes, cortical surface area, depressed affect, neuroticism, Parkinson’s disease, white matter microstructure and smoking behaviour. We describe the regulatory connections, genes and biochemical pathways that underly these co-occuring trait-SNP-gene associations. Collectively, our findings provide new avenues for the investigation of the underlying biology and diverse clinical presentations of COPD. In so doing, we identify a collection of genetic variants and genes that may aid COPD patient stratification and treatment.

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“…However, prevalence according to LLN has also been evaluated, with younger participants (40–50 years) presenting a higher prevalence of this disease defined by this criterion than by the fixed post-bronchodilator ratio established by GOLD. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

“…However, prevalence according to LLN has also been evaluated, with younger participants (40-50 years) presenting a higher prevalence of this disease defined by this criterion than by the fixed post-bronchodilator ratio established by GOLD. 17,18 In the region of Madrid prevalence of COPD only increase 1.1 percentage points between 2007 and 2017. It could be because the geographical setting, population, design and methodology of EPISCAN and EPISCAN II was very similar, unlike other epidemiological studies carried out in this regard.…”

mentioning

confidence: 99%

Prevalence of Chronic Obstructive Pulmonary Disease in an Urban Area. Changes in COPD Ten Years on

Castillo¹,

Pérez²,

Peláez³

et al. 2022

COPD

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Purpose The prevalence of Chronic obstructive pulmonary disease (COPD) in Spain has been evaluated in the last ten years by EPISCAN in 2007 and EPISCAN II in 2017. This study describes changes in the prevalence of COPD in an urban region of Spain in the last 10 years, its risk factors and underdiagnosis. Patients and Methods Participants from the Autonomous Community of Madrid (Spain) were selected from both studies up to the age of 80 years. A descriptive analysis of their sociodemographic and clinical characteristics, as well as by gender, was conducted. COPD was defined by a post-bronchodilator ratio <0.70. Results The prevalence of COPD in the Autonomous Community of Madrid increased non-significantly from 11.0% (95% CI: 8.9–13.5%) to 12.1% (95% CI: 9.6–15.1, p=0.612). However, the prevalence by gender showed an increase in women (5.6% to 14.7%, p<0.001) and a decrease in men (17.6% to 9.8%, p=0.08). Underdiagnosis was reduced from 81.0% to 67.9% (p=0.006), although with greater underdiagnosis in women (86.4% in EPISCAN and 100% in EPISCAN II). Smoking was higher in men than in women in EPISCAN (31.2% vs 23.0%, p<0.01) but with no differences by gender in EPISCAN II (25.5% men vs 26.0% women, p=0.146). Age, smoking, low BMI, and a sedentary lifestyle were consistently associated with COPD. Conclusion In 10 years in Madrid, there have been no changes in the global prevalence of COPD, but there have been important changes in women, with an increase in its prevalence, smoking habit and underdiagnosis.

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The Heterogeneity of COPD Patients in a Community-Based Practice and the Inadequacy of the Global Initiative for Chronic Obstructive Lung Disease Criteria: A Real-World Experience

Abstract: For personal use only. Permission required for all other uses.

Cited by 13 publications

References 29 publications

First Maintenance Therapy for Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

First Maintenance Therapy for Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

De novo discovery of traits co-occurring with chronic obstructive pulmonary disease

Prevalence of Chronic Obstructive Pulmonary Disease in an Urban Area. Changes in COPD Ten Years on

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