Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Figures & data

Figure 1. Treatment patterns 2005 and 2014. Treatment with different medicines or combinations, in 2005 compared with 2014. MT = maintenance treatment; LAMA = long-acting muscarinic antagonists; SAMA = short-acting muscarinic antagonists; LABA = long-acting beta-2-agonists; ICS = inhaled corticosteroids

Figure 2. Major treatments in 2014 according to GOLD 2017 groups. Proportion of the total study population distributed over main treatment groups and GOLD ABCD groups. Bronchodilator therapy includes maintenance treatment with long- or short-acting muscarinic antagonists and/or long-acting beta-2-agonists. LABA = long-acting beta-2-agonists; ICS = inhaled corticosteroids. No/other includes patients with only rescue medication and with only ICS

Table 1. Patient characteristics

	2005 N (%)	2014 N (%)
Sex
Male	451 (41%)	584 (44%)
Female	638 (59%)	745 (56%)
Age
<60	242 (22%)	167 (13%)
60–69	5427 (48%)	553 (42%)
≥70	320 (30%)	609 (46%)
Current daily smoking
No	779 (72%)	961 (74%)
Yes	308 (28%)	345 (26%)
Education
Low	734 (69%)	1030 (79%)
High	333 (31%)	269 (21%)
Body mass index
<20.0	117 (11%)	82 (6%)
20.0–24.9	368 (35%)	315 (24%)
25.0–29.9	362 (34%)	522 (41%)
≥30	206 (20%)	370 (29%)
Symptom level
CCQ <1.0	748 (79%)	856 (77%)
CCQ ≥1.0	201 (21%)	249 (23%)
CAT <10	–	806 (66%)
CAT ≥10		423 (34%)
Exacerbations in the last 6 months
0	673 (68%)	848 (66%)
≥1	368 (32%)	446 (34%)
Specific responsible doctor	524 (48%)	534 (42%)

Patient characteristics in respective cohort 2005 and 2014, reported as numbers and column percentages. High education denotes at least two years beyond the compulsory nine years of school in Sweden. CCQ = Clinical COPD Questionnaire; CAT = COPD Assessment Test.

Table 2. Treatment alternatives by level of care and sex

	Primary care			Secondary care
	2005	2014	p	2005	2014	p
No MT	310 (40%)	311 (35%)	0.029	79 (25%)	95 (22%)	0.281
LAMA/SAMA	76 (10%)	108 (12%)	0.137	32 (10%)	46 (11%)	0.874
LABA	7 (1%)	13 (2%)	0.301	4 (1%)	8 (2%)	0.546
LAMA/SAMA + LABA	20 (3%)	19 (2%)	0.541	11 (4%)	12 (3%)	0.556
ICS	45 (6%)	21 (2%)	<0.0001	14 (4%)	10 (2%)	0.097
LABA + ICS	130 (17%)	113 (13%)	0.017	49 (16%)	47 (11%)	0.051
LAMA + LABA + ICS	187 (24%)	308 (35%)	<0.0001	125 (40%)	218 (50%)	0.006
	Male			Female
	2005	2014	p	2005	2014	p
No MT	165 (37%)	216 (37%)	0.894	224 (35%)	190 (26%)	<0.0001
LAMA/SAMA	50 (11%)	68 (12%)	0.780	58 (9%)	86 (12%)	0.
LABA	4 (1%)	9 (2%)	0.349	7 (1%)	12 (2%)	0.413
LAMA/SAMA + LABA	8 (2%)	11 (2%)	0.896	23 (4%)	20 (3%)	0.326
ICS	23 (5%)	17 (3%)	0.070	36 (6%)	14 (2%)	<0.0001
LABA + ICS	71 (16%)	72 (12%)	0.115	108 (17%)	88 (12%)	0.007
LAMA + LABA + ICS	130 (29%)	191 (33%)	0.181	182 (29%)	335 (45%)	<0.0001

Treatment with different medicines or combinations, in 2005 compared with 2014, distributed over sex and level of care. MT = maintenance treatment; LAMA = long-acting muscarinic antagonists; SAMA = short-acting muscarinic antagonists; LABA = long-acting beta-2-agonists; ICS = inhaled corticosteroids.

Table 3. Major treatment alternatives in 2014 according to GOLD 2017 groups by level of care

	A		B		C		D
	PC	SC	PC	SC	PC	SC	PC	SC
No/other MT	54%	46%	35%	25%	27%	9%	19%	22%
Bronchodilator therapy	16%	16%	19%	17%	15%	13%	13%	15%
LABA + ICS	12%	12%	11%	13%	15%	8%	17%	11%
Triple inhaled therapy	18%	26%	35%	45%	43%	70%	51%	52%

Distribution of the three major recommended treatments over level of care. No/other includes patients with only rescue medication and with only ICS. Bronchodilator therapy includes maintenance treatment with long- or short-acting muscarinic antagonists and/or long-acting beta-2-agonists. GOLD = Global initiative for chronic Obstructive Lung Disease; PC = primary care; SC = secondary care; LABA = long-acting beta-2-agonists; ICS = inhaled corticosteroids; OR = odds ratio; CI = confidence interval; Ref = reference category

Table 4. Factors associated with recommended treatments in 2014

	No/other	Bronchodilator therapy OR (95% CI)	p	LABA/ICS only OR (95% CI)	p	Triple inhaled therapy OR (95% CI)	p
Female sex	Ref	1.62	0.012	1.37	0.133	2.13	<0.0001
		(1.11 to 2.35)		(0.91 to 2.06)		(1.56 to 2.91)
Age	Ref	1.03	0.100	1.00	0.803	1.02	0.180
		(1.00 to 1.06)		(0.97 to 1.03)		(0.99 to 1.04)
High education	Ref	0.80	0.313	1.03	0.909	0.70	0.063
		(0.51 to 1.24)		(0.64 to 1.64)		(0.48 to 1.02)
Underweight	Ref	0.45	0.109	1.58	0.297	1.02	0.966
		(0.17 to 1.20)		(0.67 to 3.73)		(0.50 to 2.09)
Overweight	Ref	0.44	0.001	0.66	0.058	0.62	0.019
		(0.28 to 0.70)		(0.39 to 1.10)		(0.41 to 0.93)
Obesity	Ref	0.56	0.025	0.79	0.405	0.72	0.140
		(0.34 to 0.93)		(0.45 to 1.39)		(0.47 to 1.11)
Frequent exacerbations	Ref	1.31	0.254	2.02	0.004	2.34	<0.0001
		(0.83 to 2.06)		(1.26 to 3.25)		(1.62 to 3.36)
Higher CAT score	Ref	1.03	0.040	1.04	0.002	1.07	<0.0001
		(1.00 to 1.05)		(1.02 to 1.07)		(1.05 to 1.09)
Current daily smoking	Ref	0.64	0.039	0.37	<0.0001	0.40	<0.0001
		(0.42 to 0.98)		(0.23 to 0.62)		(0.28 to 0.57))
Specific responsible doctor	Ref	2.77	<0.0001	1.70	0.014	1.95	<0.0001
		(1.89 to 4.05)		(1.12 to 2.60)		(1.41 to 2.69)

Multinomial logistic regression of the three major recommended treatments. No/other includes patients with only rescue medication and with only ICS. Bronchodilator therapy includes maintenance treatment with long- or short-acting muscarinic antagonists and/or long-acting beta-2-agonists. LABA = long-acting beta-2-agonists; ICS = inhaled corticosteroids; CAT = COPD Assessment Test; OR = odds ratio; CI = confidence interval; Ref = reference category.