The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK

Figures & data

Figure 1 Flowchart for sample selection.

Abbreviations: COPD, chronic obstructive pulmonary disease; CPRD, Clinical Practice Research Database; LABA, long-acting β₂-adrenergic agonist; LAMA, long-acting muscarinic antagonist; px, prescription.

Table 1 Patient demographics

Characteristics	All COPD patients (%) (N=8,811)	By GOLD severity
		Severity A/B (%) (n=8,371; 95% of all patients)	Severity C/D (%) (n=440; 5% of all patients)	P-value
Male	4,950 (56)	4,688 (56)	262 (60)	0.1443
Female	3,861 (44)	3,683 (44)	178 (40)
Smoking historya
Current smoker	5,577 (63)	5,257 (63)	320 (73)
Ex-smoker	1,220 (14)	1,166 (14)	54 (12)
Nonsmoker	2,010 (23)	1,944 (23)	66 (15)	0.0002
Comorbidities at diagnosis
Acute myocardial infarction	726 (8)	702 (8)	24 (5)	0.029
Congestive heart disease	490 (6)	469 (6)	21 (5)	0.459
Atrial fibrillation	607 (7)	585 (7)	22 (5)	0.109
Renal impairmentb	798 (9)	763 (9)	35 (8)	0.409
Cerebrovascular disease	511 (6)	496 (6)	15 (3)	0.028
Cancer	655 (7)	624 (7)	31 (7)	0.750
Diabetes	778 (9)	737 (9)	41 (9)	0.711
Peripheral vascular disease	589 (7)	566 (7)	23 (5)	0.209
Duration of monotherapy, years
0.5–≤1	1,570 (18)	1,447 (17)	123 (28)	<0.001
>1–2	2,693 (31)	2,535 (30)	158 (36)
>2–3	1,934 (22)	1,851 (22)	83 (19)
>3–4	1,149 (13)	1,098 (13)	51 (12)
>4–5	594 (7)	576 (7)	18 (4)
>5	871 (10)	864 (10)	7 (2)
Rate of use of short-acting medication (prescriptions per year)
Tertile 1 (≤1.9)	2,906 (33)	2,808 (34)	98 (22)	<0.001
Tertile 2 (>1.9–6.5)	2,997 (34)	2,850 (34)	147 (33)
Tertile 3 (>6.5)	2,908 (33)	2,713 (32)	195 (44)

Notes:

a At the closest time prior to diagnosis date (n=8 unspecified).

b Chronic kidney disease stages 3–5. Results are based on Chi-squared test (P<0.05).

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global initiative for chronic Obstructive Lung Disease.

Figure 2 Medication switches in patients initially prescribed LAMA or LABA monotherapy.

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-adrenergic agonist; LAMA, long-acting muscarinic antagonist.

Figure 3 Time on monotherapy by the type of therapy received at the end of the study.

Note: Thirteen patients were stepped up to a LABA + LAMA fixed-dose combination.
Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-adrenergic agonist; LAMA, long-acting muscarinic antagonist.

Table 2 Rate of outcomes

Rate of outcomes	All COPD patients (N=8,811) mean rate (95% CI)	By GOLD severity
		Severity A/B (n=8,371) mean rate (95% CI)	Severity C/D (n=440) mean rate (95% CI)	P-value
Rate of HCP interactions per yeara	14.8 (14.7, 15.1)	14.8 (14.6, 15.0)	14.6 (13.7, 15.4)	0.584
Rate of COPD exacerbations per year
Using read codes for “COPD exacerbation”	0.1 (0.1, 0.2)	0.1 (0.1, 0.1)	0.3 (0.3, 0.4)	<0.001
By addition of oral steroids and/or antibiotics to the patient’s regimeb	1.1 (1.0, 1.1)	1.1 (1.0, 1.1)	1.2 (1.1, 1.4)	0.024
Rate of referrals per year	0.7 (0.7, 0.8)	0.7 (0.7, 0.8)	0.6 (0.5, 0.6)	0.005
Rate of COPD hospitalizations (inpatient) per yearc	0.02 (0.01, 0.02) (n=4,848)	0.02 (0.01, 0.02) (n=4,591)	0.01 (0.00, 0.03) (n=257)	0.779

Notes:

a Including only face-to-face or HCP interactions and excluding >1 consultation event on the same day.

b First-line antibiotics prescription or a combination of second-line antibiotics and oral corticosteroid prescriptions (within 15 days).

c Among n=4,848 (55% of 8,811) who linked up to hospital statistics. Results are based on ordered logistic regression (P<0.05).

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; GOLD, Global initiative for chronic Obstructive Lung Disease; HCP, health care professional.

Figure 4 Frequency and rate of short-acting bronchodilator usage by monotherapy duration.

Note: Frequency (A) and rate (B) of short-acting bronchodilator usage by monotherapy duration.