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International Journal of Chronic Obstructive Pulmonary Disease Volume 16, 2021 - Issue
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Original Research

The Impact of Exacerbation Frequency on Clinical and Economic Outcomes in Swedish COPD Patients: The ARCTIC Study

Kjell Larsson1 Integrative Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenCorrespondence[email protected]
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Christer Janson2 Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, SwedenORCID Iconhttps://orcid.org/0000-0001-5093-6980View further author information
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Karin Lisspers3 Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, SwedenORCID Iconhttps://orcid.org/0000-0002-3107-4462View further author information
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Björn Ställberg3 Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, SwedenORCID Iconhttps://orcid.org/0000-0001-8497-7326View further author information
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Gunnar Johansson3 Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, SwedenORCID Iconhttps://orcid.org/0000-0001-9351-3881View further author information
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Florian S Gutzwiller4 Novartis Pharma AG, Global Patient Access, Basel, SwitzerlandORCID Iconhttps://orcid.org/0000-0001-7754-5744View further author information
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Karen Mezzi4 Novartis Pharma AG, Global Patient Access, Basel, SwitzerlandView further author information
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Bine Kjoeller Bjerregaard5 IQVIA Solutions, Real World Evidence Solutions, Copenhagen, DenmarkView further author information
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Leif Jorgensen5 IQVIA Solutions, Real World Evidence Solutions, Copenhagen, DenmarkView further author information
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Pages 701-713 | Published online: 18 Mar 2021

Figures & data

Table 1 Baseline Characteristics of 18,586 Patients with COPD Stratified by Exacerbation Rate

Table 2 Lung Function After Bronchodilatation in COPD Patients Stratified by Exacerbation Rate

Figure 1 Exacerbation rate at baseline and during each year of follow-up in COPD patients with (n=18,586) and without (n=15,920) a concurrent asthma diagnosis.

Notes: The percent of patients that remains in the same group as in the previous period of one year is calculated. The most dynamic group is the group with 1 exacerbation per year, where only around one out of three patients remain in the same group as in the previous one-year period. Around two out of three patients who experienced 0 and ≥2 exacerbations remained in the same group, ie, having 0 or ≥2 annual exacerbations also during follow-up. The pattern is similar in all COPD patients and when COPD without an asthma diagnosis have been deleted.
Figure 1 Exacerbation rate at baseline and during each year of follow-up in COPD patients with (n=18,586) and without (n=15,920) a concurrent asthma diagnosis.

Figure 2 Exacerbation rate during the first three years of follow-up after index date in 18,586 patients with COPD.

Note: The green, yellow and red color bars represent the groups of patients with 0.1 or ≥2 exacerbations during the first, second and third year of follow-up, respectively.
Figure 2 Exacerbation rate during the first three years of follow-up after index date in 18,586 patients with COPD.

Figure 3 Mortality related to the average number of annual exacerbations during the complete follow-up period before death in COPD patients with (n=18,586) and without (n=15,920) a concurrent asthma diagnosis.

Figure 3 Mortality related to the average number of annual exacerbations during the complete follow-up period before death in COPD patients with (n=18,586) and without (n=15,920) a concurrent asthma diagnosis.

Figure 4 Post bronchodilator lung function decline related to exacerbation rate during follow-up in COPD patients with (n=18,586) and without (n=15,920) a concurrent asthma diagnosis.

Notes: Data are given for patients who had experienced, on average, 0, 1, or ≥2 exacerbations per year during follow-up. Lung function (FEV1) decline is based on three or more measurements and given as post-bronchodilator FEV1 decline in mL/year. Mean values and 95% confidence interval.
Abbreviation: FEV1, forced expiratory volume in one second.
Figure 4 Post bronchodilator lung function decline related to exacerbation rate during follow-up in COPD patients with (n=18,586) and without (n=15,920) a concurrent asthma diagnosis.

Figure 5 Cumulative dispensation, representing prescription during the preceding year, of respiratory drugs during a follow-up period of 8 years in 18,586 patients with COPD.

Abbreviations: ICS, inhaled steroids; LABA, long-acting beta-agonists; LAMA, long-acting antimuscarinics; SABA, short-acting beta-agonists; SAMA, short-acting antimuscarinics.
Figure 5 Cumulative dispensation, representing prescription during the preceding year, of respiratory drugs during a follow-up period of 8 years in 18,586 patients with COPD.

Figure 6 Total direct costs excluding drug costs (A) and costs for drugs in COPD patients (B) with 0, 1 and ≥2 exacerbations per year during 11 years of follow-up.

Figure 6 Total direct costs excluding drug costs (A) and costs for drugs in COPD patients (B) with 0, 1 and ≥2 exacerbations per year during 11 years of follow-up.

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