Characteristics of Patients with Chronic Obstructive Pulmonary Disease Treated with Long-Acting Bronchodilators in a Real-World Setting in Singapore: A Single-Center Observational Study

Abstract

Introduction

There is limited real-world evidence regarding clinical practice for chronic obstructive pulmonary disease (COPD) in Singapore. We compared baseline clinical characteristics and evaluated outcomes in patients with COPD who initiated treatment with either a long-acting muscarinic antagonist (LAMA) or a LAMA and a long-acting β₂-agonist (LAMA+LABA).

Methods

This was a single-center observational study at Changi General Hospital, Singapore. Routine clinical data (hospital visits, case management, lung function, laboratory/imaging results, medication orders) were collected and compiled into a data warehouse. Eligible patients with COPD were ≥40 years old and newly prescribed LAMA or LAMA+LABA during the enrollment period. Patient characteristics in the baseline period (6 months) were compared between treatments. Clinical worsening was measured as a composite endpoint, defined as the first of a change in maintenance treatment class or a moderate-to-severe exacerbation during follow-up (12 months).

Results

In total, 261 patients were included in the baseline period (LAMA: 73; LAMA+LABA: 188). In the baseline period, patients receiving LAMA+LABA versus LAMA had significantly lower body mass index, higher COPD Assessment Test score and worse lung function, and numerically higher exacerbation history. Prevalence of comorbidities was similar between treatment groups. In follow-up, high rates of clinical worsening were observed regardless of treatment regimen (LAMA: 38/73 [52%]; LAMA+LABA: 86/188 [46%]). Median time-to-clinical worsening was 340 days for the LAMA cohort and the raw median 154 days (interquartile range: 44–225) for the LAMA+LABA cohort. Median medication dispensation rate (0.86; interquartile range: 0.56–1.00) was similar between treatments.

Conclusion

Patients initiating treatment with LAMA+LABA had more severe COPD than patients prescribed LAMA. The proportion of patients experiencing clinical worsening was similarly high in both cohorts, suggesting that early identification and treatment optimization are necessary.

Keywords:

• COPD treatment
• database analysis
• dual bronchodilator
• LABA
• LAMA
• inhaler prescription

Abbreviations

ATS, American Thoracic Society; BMI, body mass index; CAT, COPD Assessment Test; CGH, Changi General Hospital; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ED, emergency department; FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroid; IQR, interquartile range; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; SD, standard deviation.

Data Sharing Statement

Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com. Availability of data owned by CGH may be subject to restrictions.

Ethics Approval and Informed Consent

This study complied with all applicable laws regarding personal data protection. No direct patient contact or primary collection of individual human patient data occurred. Study results were captured in a tabular form and aggregate analyses omitted patient identification. Informed consent, ethics committee or Institutional Review Board approval was not required as deidentified data were used. This study was granted exemption by the Singhealth Centralised Institutional Review Board (2018/2698). In accordance with Singhealth personal data protection policies, the data were submitted to a trusted third party for deidentification and/or anonymization prior to analysis.

Consent for Publication

Patient consent is not required as all data are anonymized.

Acknowledgments

Editorial support (in the form of writing assistance during development of the initial draft, assembling tables and figures, collating authors comments, grammatical editing, and referencing) was provided by Maria Guillermina Casabona, PhD, of Fishawack Indicia Ltd, UK, part of Fishawack Health, and was funded by GSK.

Author Contributions

All authors took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

MS reports non-financial support from GSK for manuscript writing support, during the conduct of the study. AY reports grants, non-financial support from GSK, during the conduct of the study. AT reports grants from GSK for supporting the systems integration of the COPD database, during the conduct of the study. XX and PB are employees of GSK. AANR and DM are employees of GSK and hold stock and shares at GSK. The authors report no other conflicts of interest in this work.

Additional information

Funding

The data warehouse used in this study was funded by GlaxoSmithKline (GSK study 215242). GSK employees were involved in the study design, the analysis of the aggregated data, and the writing of the manuscript. GSK was not involved in data collection or patient management and did not have access to any identifiable patient data.