COPD Exacerbation Frequency, Pharmacotherapy and Resource Use: An Observational Study in UK Primary Care

Abstract

Chronic Obstructive Pulmonary Disease (COPD) management represents a significant health resource use burden. Understanding of current resource use, treatment strategies and outcomes can improve future COPD management, for patient benefit and to aid efficient service delivery. This study aimed to describe exacerbation frequency, pharmacotherapy and health resource use in COPD management in routine UK primary care. A retrospective, observational study using routine clinical records of 511 patients with COPD, was undertaken in 10 General Practices in England. Up to 3 years’ patient data were collected and analysed. 75% (234/314) patients with mild-moderate COPD (≥50% predicted FEV₁) received inhaled corticosteroids (ICS). 11% of patients (54/511) received ICS monotherapy. Mean (standard deviation) annual exacerbation frequency was 1.1 (1.2) in mild-moderate, 1.7 (1.6) in severe (30–49% predicted FEV₁) and 2.2 (2.0) in very severe (<30% predicted FEV₁) COPD. 14% patients (69/511) had a mean exacerbation frequency of ≥3/year (‘frequent-exacerbators’); 9% (27/314) of patients with mild-moderate, 19% (27/145) with severe and 29% (15/52) with very severe COPD. 14% (10/69) of frequent-exacerbators failed to receive inhaled long-acting beta agonists (LABA), 25% (17/69) inhaled long-acting muscarinic antagonists (LAMA), and 12% (`/69) ICS. Frequent-exacerbators had a median of 6.67 primary care contacts/year, 1.0 secondary care visits/year and 21% were hospitalised for COPD/year. Inhaled therapy was frequently inappropriate, with over-use of ICS in patients with mild-moderate COPD. COPD exacerbations were associated with high health resource use and occurred at all levels of disease severity. COPD management strategies should encompass risk-stratification for both exacerbation frequency and physiological impairment.

Keywords :

• Health economics
• Inhaled corticosteroids
• long-acting beta agonists
• long-acting muscarinic antagonists
• retrospective study
• disease severity

Acknowledgments

The authors wish to thank the following medical practices for their contribution to the study: Minchinhampton Surgery, Stroud; Carterknowle & Dore Medical Practice, Sheffield; Park Surgery, Chandlers Ford, Southampton; Burbage Surgery, Burbage, Hinckley; Dr Pearston & Partners, Newcastle; Albany House Medical Centre, Wellingborough; Ash Vale Health Centre, Ashvale, Aldershot; Sherbourne Medical Centre, Leamington Spa; The Surgery, Litherland, Liverpool; Dr I D Caldwell & Partners, Daubhill, Bolton.

Declaration of Interest Statement

Neither Prof. Mike Thomas nor any member of his close family has any shares in pharmaceutical companies. In the last 3 years he has received speaker's honoraria for speaking at sponsored meetings from the following companies marketing respiratory and allergy products: Astra Zeneca, Boehringer Ingelheim, GSK, MSD, Napp, Schering-Plough, Teva. He has received honoraria for attending advisory panels with; Almirall, Astra Zeneca, BI, Chiesi, GSK, MSD, Merck Respiratory, Schering-Plough, Teva, Novartis. He has received sponsorship to attend international scientific meetings from: GSK, MSD, Astra Zeneca, Mundipharma. He has received funding for research projects from: GSK, Almirall. He is Chief Medical Advisor to the charity Asthma UK, a member of the BTS SIGN Asthma guideline group. He is a member of the EPOS Rhinosinusitis guideline group.

Dr Amr Radwan was employed by Novartis Pharmaceuticals UK and owns shares in the company.

Carol Stonham has received payment for lecturing and advisory work on an occasional basis, from the following companies: Astra Zeneca, GSK, MSD, Chiesi, Napp and Novartis. She has received payment from MSD for the development of educational presentations relating to the ASCEND asthma education programme. She is PCRS-UK Executive Committee member and Nurse Chair.

Samantha Marshall is an employee of pH Associates, a professional consultancy specialising in the design, implementation and analysis of real world data projects. pH Associates received payment from Novartis to undertake this work.

This study was funded by Novartis Pharmaceuticals UK Ltd. Novartis personnel contributed to the study design and provided support with data collection, data analysis and manuscript preparation, via the contracted services of pH Associates.