Exacerbation Frequency And Eosinophil Counts Among Patients With COPD Currently Prescribed Triple Therapy

Figures & data

Table 1 Patient Demographics And Clinical Characteristics Overall And For Each Country

	Total Population^a (N=2876)	France (n=565)	Germany (n=587)	Italy (n=580)	Spain (n=583)	UK (n=561)
Age (years), mean (SD)	66.2 (9.7)	64.7 (10.3)	62.9 (9.8)	69.6 (6.6)	68.1 (9.2)	65.9 (10.7)
Female, %	33.2	29.6	31.5	39.7	24.9	40.5
BMI (kg/m^2), mean (SD)	26.5 (4.3)	26.0 (4.7)	26.2 (3.9)	26.5 (3.2)	27.3 (4.1)	26.6 (5.3)
Current smoker, %	30.6	38.0	35.1	24.0	23.2	32.7
Caregiver required, %	9.2	7.4	6.2	8.4	11.4	12.8
Current (selected) comorbidities, %
Myocardial infarction	4.2	2.9	3.9	2.6	4.5	7.0
Congestive heart failure	6.7	4.0	7.5	4.6	10.8	6.4
Peripheral vascular disease	6.5	5.1	9.4	4.6	7.1	5.9
Arthritis	7.3	2.9	6.9	7.4	6.4	13.4
Diabetes	15.8	13.4	14.9	15.3	22.6	12.7
Currently prescribed maintenance COPD therapy
COPD maintenance therapy, %	96.5	98.1	93.2	99.3	98.5	93.6
Maintenance class combinations	n=2776	n=554	n=547	n=576	n=574	n=525
Triple therapy (any combination of ICS + LABA + LAMA), %	29.2	32.5	19.6	17.5	36.1	41.1
ICS/LABA FDC only, %	17.8	19.7	15.9	27.6	9.2	16.4
LAMA only, %	23.1	13.7	26.5	35.4	18.1	21.1
LAMA/LABA FDC only, %	19.3	15.0	24.5	13.0	28.7	14.9
LABA only, %	3.8	7.4	5.9	1.4	2.6	1.9
Other maintenance, %	6.8	11.7	7.7	5.0	5.2	4.6
Current usage of slow-release theophyllines (with other treatment), %	2.0	0.7	2.2	0.2	1.4	5.5
mMRC score	n=1527	n=268	n=482	n=278	n=295	n=204
≥2, %	40.7	39.2	35.5	43.2	44.8	46.1
CAT score	n=1528	n=267	n=480	n=280	n=300	n=201
≥10, %	87.2	91.0	78.8	98.9	88.7	83.6
Mean (SD)	20.2 (8.3)	20.2 (7.4)	18.4 (9.4)	24.0 (5.1)	20.2 (8.1)	19.3 (8.6)
EQ-5D-3L and EQ-VAS	n=1542	n=273	n=490	n=282	n=297	n=200
Mean (SD)	0.77 (0.25)	0.67 (0.33)	0.84 (0.18)	0.84 (0.10)	0.70 (0.30)	0.74 (0.24)
COPD-related healthcare resource utilization in the year prior to index date
Number of primary care visits	n=1423	n=276	n=294	n=283	n=294	n=276
Mean (SD)	4.8 (3.8)	6.4 (4.1)	4.4 (3.3)	5.1 (3.3)	4.8 (4.4)	3.5 (3.3)
Number of specialist care visits	n=1453	n=289	n=293	n=297	n=289	n=285
Mean (SD)	3.4 (3.4)	2.9 (1.8)	4.0 (2.0)	4.1 (6.2)	3.1 (2.5)	2.8 (2.0)
Number of inpatient days in hospital	n=2876	n=565	n=587	n=580	n=583	n=561
Mean (SD)	1.8 (5.1)	1.5 (4.7)	2.6 (6.6)	0.5 (2.0)	2.3 (6.1)	2.0 (4.7)
Number of moderate and/or severe exacerbations per person in the last 12 months
0, %	54.1	49.2	67.5	56.7	48.4	48.5
1, %	6.0	6.2	7.2	4.8	8.4	3.2
≥2, %	39.9	44.6	25.4	38.4	43.2	48.3
Mean (SD)	1.7 (2.7)	1.7 (2.2)	1.0 (2.0)	1.5 (2.5)	2.1 (3.0)	2.4 (3.3)
FEV1/FVC measured, n (%)	1864 (64.8%)	352 (62.3%)	294 (50.1%)	380 (65.5%)	441 (75.6%)	397 (70.8%)
% predicted post bronchodilator FEV1, mean (SD)	63.0 (16.0)	60.5 (17.7)	67.3 (15.3)	63.0 (10.1)	60.7 (17.9)	61.3 (18.0)
Blood eosinophil count^b (cells/µL)	n=762	n=139	n=123	n=23	n=216	n=261
≥150 cells/µL, %	73.0	82.7	76.4	78.3	75.0	64.0
≥300 cells/µL, %	33.6	38.1	27.6	52.2	36.6	29.9
Geometric mean (95% CI)	257.5 (243.6, 271.4)	292.5 (258.9, 326.1)	267.7 (227.6, 307.8)	295.9 (227.9, 363.9)	269.5 (239.9, 299.2)	220.8 (203.3, 238.2)

Notes: ^aTotal population from France, Germany, Italy, Spain, and UK; ^bMost recent measurement recorded.

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; CI, confidence interval; EQ-5D-3L, EuroQol 5-Dimension 3-level questionnaire; EQ-VAS, visual analogue scale; FDC, fixed-dose combination; FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic receptor antagonist; mMRC, Modified Medical Research Council Dyspnea Scale; SD, standard deviation.

Table 2 Demographics And Clinical Characteristics Of Patients Stratified By Blood Eosinophil Counts

	Blood Eosinophils Measured (N=989)				Blood Eosinophils Not Measured (N=1887)
	Total Population (N=989^a)	EOS <150 Cells/µL (n=206)	EOS 150–<300 Cells/µL (n=300)	EOS ≥300 Cells/µL (n=256)
Age	n=981	n=205	n=299	n=253	N=1879
Years, mean (SD)	66.0 (10.5)	66.0 (10.2)	66.0 (9.9)	66.2 (11.2)	66.4 (9.3)
Female, %	33.1	42.2	30.7	30.5	33.2
BMI (kg/m^2), mean (SD)	26.5 (4.9)	25.8 (5.0)	26.6 (5.2)	26.8 (4.8)	26.5 (3.9)
Smoking status	n=977	n=202	n=297	n=251	n=1847
Current smoker, %	31.7	30.7	32.7	28.7	29.9
Caregiver status	n=955	n=202	n=291	n=248	n=1822
Caregiver required, %	14.2	16.3	13.1	15.7	6.6
Current (selected) comorbidities	n=963	n=198	n=293	n=247	n=1840
Myocardial infarction, %	5.6	4.5	4.4	7.7	3.4
Congestive heart failure, %	8.6	11.1	8.9	6.5	5.7
Peripheral vascular disease, %	8.4	8.1	7.2	10.5	5.4
Arthritis, %	7.9	8.6	8.9	9.7	7.1
Diabetes, %	16.9	16.7	14.7	21.5	15.3
Current prescribed maintenance COPD therapy
COPD maintenance therapy, %	97.4	96.6	98.0	96.5	96.1
Maintenance class combinations	n=963	n=206	n=294	n=247	n=1813
Triple therapy (any combination of ICS + LABA + LAMA), %	38.1	40.2	41.8	37.7	24.5
ICS/LABA FDC only, %	12.4	11.1	11.9	13.4	20.7
LAMA only, %	18.2	18.6	17.0	16.2	25.6
LAMA/LABA FDC only, %	22.0	23.1	20.1	23.9	17.8
LABA only, %	2.1	1.5	1.7	1.2	4.7
Other maintenance, %	7.3	5.5	7.5	7.7	6.6
Current usage of slow-release theophyllines (with other treatment), %	3.8	6.3	4.0	3.9	1.0
mMRC score	n=503	n=97	n=169	n=128	n=1024
≥2, %	41.6	48.5	39.1	35.9	40.3
CAT score	n=505	n=97	n=170	n=130	n=1023
≥10, %	89.9	86.6	88.2	90.8	85.8
Mean (SD)	20.8 (8.0)	21.0 (8.8)	19.7 (8.0)	20.9 (7.5)	19.9 (8.4)
EQ-5D-3L and EQ-VAS	n=504	n=96	n=170	n=131	n=1038
Mean (SD)	0.71 (0.29)	0.71 (0.30)	0.75 (0.26)	0.65 (0.33)	0.80 (0.22)
COPD-related healthcare resource utilization in the year prior to index date
Number of primary care visits	n=473	n=75	n=108	n=162	n=950
Mean (SD)	5.9 (4.8)	5.2 (5.6)	5.5 (4.3)	6.0 (4.8)	4.3 (3.1)
Number of specialist care visits	n=516	n=131	n=192	n=94	n=937
Mean (SD)	3.5 (2.5)	3.5 (2.8)	3.4 (2.2)	3.6 (3.0)	3.3 (3.8)
Number of inpatient days in hospital	n=989	n=206	n=300	n=256	n=1887
Mean (SD)	2.6 (6.5)	3.4 (7.4)	2.2 (5.4)	2.8 (6.8)	1.2 (3.8)
Number of moderate and/or severe exacerbations per person in the last 12 months
0, %	44.4	48.5	46.0	37.5	59.2
1, %	5.8	4.4	5.3	6.6	6.1
≥2, %	49.8	47.1	48.7	55.9	34.7
Mean (SD)	2.4 (3.2)	2.4 (3.6)	2.1 (2.6)	2.7 (3.3)	1.4 (2.3)
% predicted post bronchodilator FEV1, mean (SD)	58.7 (17.2)	55.4 (18.1)	59.1 (17.0)	60.2 (16.0)	65.2 (14.8)
Most recent record of blood eosinophil count (cells/uL)	n=762	n=206	n=300	n=256	n=0
Geometric mean (95% CI)	257.5 (243.6, 271.4)	90.9 (86.2, 95.6)	200.2 (196.9, 203.6)	458.7 (432.7, 484.8)	N/A

Notes: ^aOf 989 patients who had a blood eosinophil count measured, 762 had a value and 227 were measured but had no value recorded.

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; CI, confidence interval; EQ-5D-3L, EuroQol 5-Dimension 3-level questionnaire; EQ-VAS, visual analogue scale; FDC, fixed-dose combination; FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic receptor antagonist; mMRC, Modified Medical Research Council Dyspnea Scale; SD, standard deviation.

Table 3 Demographics And Clinical Characteristics Of Patients With COPD By Exacerbations History/Current Therapy

	Patients With COPD With ≥ 2 Moderate or ≥ 1 Severe AECOPD Within The Last 12 Months And Currently Being Treated With Triple Therapy (n=546)	Total COPD Population (n=2330)
Age	n=540	n=2320
Years, mean (SD)	68.7 (9.4)	65.7 (9.7)
Female, %	29.1	34.1
BMI (kg/m^2), mean (SD)	n=507 26.9 (4.8)	n=2240 26.4 (4.1)
Smoking status	n=536	n=2228
Current smoker, %	29.3	30.9
Caregiver status	n=534	n=2243
Caregiver required, %	19.5	6.8
Current (selected) comorbidities	n=540	n=2263
Myocardial infarction, %	6.7	3.6
Congestive heart failure, %	13.9	5.0
Peripheral vascular disease, %	9.3	5.8
Arthritis, %	7.2	7.4
Diabetes, %	22.0	14.4
Current prescribed treatment
COPD maintenance therapy, %	100	95.7
Maintenance class combinations	n=546	n=2230
Triple therapy (any combination of ICS + LABA + LAMA), %	100	11.9
ICS/LABA FDC only, %	0	22.2
LAMA only, %	0	28.7
LAMA/LABA FDC only, %	0	24.0
LABA only, %	0	4.8
Other maintenance, %	0	8.5
Current usage of slow-release theophyllines (with other treatment), %	6.2	1.0
mMRC score	n=256	n=1271
≥2, %	69.1	35.0
CAT score	n=263	n=1265
≥10, %	95.4	85.5
Mean (SD)	24.9 (7.3)	19.2 (8.1)
EQ-5D-3L and EQ-VAS	n=260	n=1282
Mean (SD)	0.63 (0.32)	0.80 (0.22)
COPD-related healthcare resource utilization in the year prior to index date
Number of primary care visits	n=223	n=1200
Mean (SD)	6.3 (4.5)	4.6 (3.6)
Number of specialist care visits	n=323	n=1130
Mean (SD)	3.8 (2.3)	3.2 (3.7)
Number of inpatient days in hospital	n=546	n=2330
Mean (SD)	3.1 (7.2)	0.9 (2.9)
% predicted post bronchodilator FEV1, mean (SD)	n=276 53.5 (16.3)	n=1038 65.6 (14.9)
Most recent record of blood eosinophil count (cells/uL)	n=209	n=553
≥150 cells/µL, %	73.7	72.7
≥300 cells/µL, %	33.5	33.6
Geometric mean (95% CI)	243.6 (221.4, 265.9)	262.8 (245.6, 280.0)

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; CI, confidence interval; EQ-5D-3L, EuroQol 5-Dimension 3-level questionnaire; EQ-VAS, visual analogue scale; FDC, fixed-dose combination; FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic receptor antagonist; mMRC, Modified Medical Research Council Dyspnea Scale; SD, standard deviation.

Figure 1 Proportion of patients from the total diagnosed COPD sample (weighted absolute percentages) who were prescribed triple therapy, had ≥2 moderate or ≥1 severe AECOPD, and had a blood eosinophil count ≥150 cells/µL and ≥300 cells/µL in the five European countries studied.

Notes: ^aWeighted using an adjustment factor to account for physician consultation rates, and consultation workload, physician specialty, and country size; ^bFrance, Germany, Italy, Spain, and UK; ^cBased on the total with eosinophil count collected as part of routine clinical care (n=762).
Abbreviations: AECOPD, acute exacerbations of COPD; COPD, chronic obstructive pulmonary disease; EOS, blood eosinophil count.

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