Introduction and objectives National Institute for Health and Care Excellence (NICE) recommends long–acting bronchodilators, including β2-agonists (LABAs) or muscarinic antagonists (LAMAs) as first line maintenance treatment for patients with COPD. The aim of this descriptive study was to characterise a cohort of COPD patients who were on maintenance bronchodilator monotherapy for at least six months to establish their disease burden, measured by healthcare utilisation.
Methods Data were extracted from the UK Clinical Practice Research Datalink (CPRD) which also linked to Hospital Episode Statistics (HES). The monotherapy period spanned the first prescription of a LABA or LAMA until the end of the study period (31/12/2013) or until step-up to dual/triple therapy; for example the addition of another long acting bronchodilator, an ICS or ICS/LABA. A minimum of four consecutive prescriptions and six months on continuous monotherapy were required for study entry. Patients <50 years old at time of first COPD diagnosis or with another significant respiratory disease prior to the start of monotherapy were excluded. Disease burden was evaluated by measuring patients’ rate of consultations with a healthcare professional (HCP), COPD-related exacerbations, hospitalisations and referrals to key specialities.
Results A cohort of 8,811 COPD patients (94% GOLD stage A or B) on maintenance monotherapy was identified between 2002 and 2013; 45% (N=3,947) of these patients were still on monotherapy by the end of the study period. The median time from first COPD diagnosis to first monotherapy prescription was 56 days while the median time on maintenance bronchodilator monotherapy was 748 days. The median number of prescriptions during this period was 14. Patients had a median of 19 HCP consultations and a mean of 0.1 (95% CI 0.1, 0.2, N= 8,811) COPD exacerbations and 0.02 (95% CI 0.01, 0.02, N=4,848) COPD hospitalisations per year.
Conclusion In summary, COPD patients who are on maintenance bronchodilator monotherapy for at least six months appear to remain on this therapy for over two years despite having a disease burden that requires healthcare resources, particularly HCP consultations, at a cost to the NHS.
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