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

Figures & data

Table 1.  Number of patients consenting / included at each centre

Centre	Region	No. patients identified	No. consents sent	No. patients consenting	No. patients included
1 - Minchinhampton, Gloucester	South West	98	98	56	56
2 - Sheffield	Yorkshire & Humber	117	117	58	57
3 - Eastleigh, Southampton	South East	105	105	53	53
4 - Hinckley, Leicester	East Midlands	106	106	40	40
5 - Newcastle	North East	300+	200	116	68
6 - Wellingborough, Northampton	East Midlands	700+	160	89	85
7 - Ashvale, Aldershot	South East	160	160	60	52
8 - Leamington Spa	West Midlands	156	47	31	30
9 - Liverpool	North West	60	60	30	26
10 - Bolton	North West	171	100	44	44
Total		–	–	–	511

Table 2.  Patient demographics and study sample

Patient demographics and study sample (n = 511) Mean (SD) time (years) from diagnosis to data collection Mean (SD) age at COPD diagnosis (years)	7.95 (5.32)65.85 (10.23)
Gender –n (%) Male Female	266 (52%)245 (48%)
COPD severity (according to FEV1) in 2007 –n (%) Mild-moderate (≥50% predicted FEV1) Severe (30–49% predicted FEV1) Very severe (<30% predicted FEV1)	314 (61%)145 (28%) 52 (10%)
Recorded co-morbidities –n (%) Asthma Rhinitis Ischaemic heart disease High BMI Gastric reflux Low BMI Osteoporosis Depression Type II diabetes mellitus One or more of above co-morbidities	162 (32%) 33 (6%)133 (26%)105 (21%) 57 (11%) 35 (7%) 46 (9%) 73 (14%) 72 (14%)396 (77%)

Figure 1.  Distribution of number of COPD exacerbations/year, by disease severity.

Table 3.  Recorded co-morbidities, stratified by exacerbation frequency

	Exacerbation frequency grouping
Co-morbidity –n (%) patients	Non-exacerbators (n = 97)	Infrequent-exacerbators (n = 345)	Frequent-exacerbators (n = 69)	P-value (Fisher's exact probability test) for non-exacerbators vs. frequent-exacerbators
Asthma	31 (32%)	106 (31%)	25 (36%)	>0.1
Rhinitis	7 (7%)	22 (6%)	4 (6%)	>0.1
Ischaemic heart disease	23 (24%)	92 (27%)	18 (26%)	>0.1
High BMI	21 (22%)	78 (23%)	6 (9%)	0.02
Gastric reflux	9 (9%)	43 (12%)	5 (7%)	>0.1
Low BMI	4 (4%)	24 (7%)	7 (10%)	>0.1
Osteoporosis	9 (9%)	27 (8%)	10 (14%)	>0.1
Depression	5 (5%)	51 (15%)	17 (25%)	<0.001
Type II diabetes mellitus	17 (18%)	43 (12%)	12 (17%)	>0.1
Any of the above co-morbidities	70 (72%)	264 (77%)	62 (90%)	0.004

Figure 2.  Distribution of personnel seen during COPD-related primary care contacts for routine or exacerbation management. ^aPercentage of all recorded primary care contacts occurring during the study period. Includes GP surgery visits, home visits and telephone contacts. ^b'Other’ is comprised predominantly of Community Respiratory Team and physiotherapist contacts.

Table 4.  Resource use, stratified by COPD severity

	COPD severity
	Mild-moderate (n = 314)	Severe (n = 145)	Very severe (n = 52)
Median (IQR) no. of primary care COPD contacts/year	2.33(1.45–3.33)	3.33(2.33–5.00)	3.67(2.67–6.42)
Median (IQR) no. of secondary care COPD visits/year	0.00(0.00–0.33)	0.33(0.00–1.00)	1.00(0.00–2.08)
Median (IQR) no. of COPD hospitalisations/year	0.00(0.00–0.00)	0.00(0.00–0.00)	0.00(0.00–0.33)
N (%) patients hospitalised for COPD/year^a	13.3(4%)	14.3(10%)	8.3(16%)
Median (IQR) length of hospital stay (days)	5(2–10)	5(2–9)	6(3–11)

^aNumber of patients hospitalised per year is the mean of the number of patients hospitalised in each year of the 3 year observation period, hence not a whole number.

Table 5.  Resource use, stratified by exacerbation frequency

	Exacerbation frequency group
	Non-exacerbators(n = 97)	Infrequent-exacerbators (n = 345)	Frequent-exacerbators(n = 69)
Median (IQR) no. of primary care COPD contacts/year	1.33(0.67–2.00)	2.67(2.00–3.67)	6.67(5.33–8.67)
Median (IQR) no. of secondary care COPD visits/year	0.00(0.00–0.00)	0.00(0.00–0.67)	1.00(0.33–2.67)
Median (IQR) no. of COPD hospitalisations/year	0.00(0.00–0.00)	0.00(0.00–0.00)	0.00(0.00–0.33)
N (%) patients hospitalised for COPD/year^a	0.7(1%)	21.0(6%)	14.3(21%)
Median (IQR) length of hospital stay (days)	7.00(6–8)	5.50(3–10)	5.00(2–10)

^aNumber of patients hospitalised per year is the average (mean) of the number of patients hospitalised in each year of the observation period, hence not a whole number.

Figure 3.  Proportion of patients prescribed ICS during the study period, according to COPD severity, presence of asthma and exacerbation frequency. ^an values show the total number of patients within each sub-group. ^bThe boxes below the n values show the number (and percentage) of patients within each sub-group who were prescribed ICS during the study period.

Table 6.  Drug treatments prescribed for routine COPD management during the observation period –according to exacerbation frequency

	Exacerbation frequency group
	Non-exacerbators(n = 97)	Infrequent-excerbators(n = 345)	Frequent- exacerbators(n = 69)	Overall (n = 511)
Drug treatments^a
Any LABA (single agent or combination LABA-ICS device)	64 (66%)	280 (81%)	59 (86%)	403 (79%)
Any LAMA	40 (41%)	203 (59%)	52 (75%)	295 (58%)
Any ICS (single agent or combination LABA-ICS device)	66 (68%)	286 (83%)	61 (88%)	413 (81%)
Drug combinations^a
ICS monotherapy (without LABA or LAMA)	18 (19%)	32 (9%)	4 (6%)	54 (11%)
LABA monotherapy (without LAMA or ICS)	10 (10%)	22 (6%)	1 (1%)	33 (6%)
LAMA monotherapy (without LABA or ICS)	12 (12%)	69 (20%)	14 (20%)	95 (19%)
LABA + LAMA (without ICS)	8 (8%)	13 (4%)	0 (0%)	21 (4%)
LABA and/or LAMA (without ICS)	23 (24%)	92 (27%)	15 (22%)	130 (25%)
LABA + ICS (without LAMA)	40 (41%)	175 (51%)	35 (51%)	250 (49%)
LAMA + ICS (without LABA)	4 (4%)	12 (3%)	3 (4%)	19 (4%)
LABA+LAMA+ICS	27 (28%)	163 (47%)	46 (67%)	236 (46%)
LABA and/or LAMA (with ICS)	59 (61%)	274 (79%)	60 (87%)	393 (77%)

^aDrug treatments are not mutually exclusive, reflecting the fact that patients may have moved between different combinations of drugs during the observation period.