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Early Identification, Treatment of COPD Reduces Exacerbations, Health Care Burden
CHEST 2024. Initial treatment for people with COPD should begin early in the disease and leads to significantly reduced risk for exacerbations and inpatient treatment.
In treatment-naïve adults with chronic obstructive pulmonary disease (COPD) who have experienced a disease exacerbation a new study underscores the importance of early identification and treatment initiation—with the introduction of treatment more important than the choice of dual or triple inhaled therapy, at least to start.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides recommendations for initial pharmacologic treatment (IPT) for adults with the obstructive lung disease but according to study authors, there are few real-world data on what type of medications are selected for early treatment or on initial outcomes. Their research compared COPD exacerbations and health care utilization, ie, hospitalizations, during a 12-month baseline period prior to IPT with the 2 variables during the 12-month follow-up period after IPT.
The retrospective cohort study tapped the US Optum Research Database for information on adults aged 40 years and older with COPD and a history of exacerbations who began IPT from September 1, 2027, to March 31, 2022, and maintained continuous insurance coverage pre- and post-IPT date. IPT was stratified as single inhaler dual inhaled therapy with a LABA/LAMA or ICS/LABA or single inhaler triple inhaled therapy with LABA/LAMA/ICS.
The final cohort comprised 29 373 participants who had an average age of approximately 70 years. Approximately half were women and three-quarters self-identified as White. The mean Charlson Comorbidity score across IPT groups was 2.5. The proportion of participants initiating each of the 3 treatments was:
- LABA/LAMA/ICS 12.4%
- LABA/LAMA 25.7%
- ICS/LABA 74.3%
FINDINGS
During baseline vs follow-up, the mean number of COPD exacerbations among single inhaler triple therapy initiators was 1.5 vs 0.8 and the proportion of participants with 1 or more COPD-related inpatient stays was 20% vs 12.8%. Researchers reported the mean length of hospital stay (LoS) was 13.1 days (baseline) vs 16.4 days (follow-up).
Among participants who initiated inhaled dual therapy with LABA/LAMA, the mean number of exacerbations at baseline vs follow-up was 1.4 and 0.7, respectively. In this subgroup, the number of participants who had at least 1 COPD-related inpatient stay was 20.5% at baseline vs 10.7% during follow-up; the mean LoS was 12.2 days at baseline vs 18.4 days during follow-up.
Findings for participants whose first treatment was with inhaled dual therapy with ICS/LABA paralleled those for the LABA/LAMA initiators, with mean exacerbations recorded as 1.4 at baseline vs 0.7 at follow-up. The proportion of ICS/LABA initiators with 1 or more hospitalizations was 23.6% vs 12.1%, at baseline and follow-up, respectively. The average LoS in this subgroup was 13.3 days vs 19.5 days.
"We looked across the common maintenance therapies to see what happened with exacerbations and hospitalizations, and, of course, patients improved once they were treated, but it helped us see the unmet need of really identifying patients early, getting that assessment, and getting them an appropriate treatment," presenter Kristi DiRocco, PharmD, respiratory medical director at GSK, told Patient Care® partner site The American Journal of Managed Care.® during the meeting.
“These findings may help inform future real-world studies investigating triple and dual therapies as IPT, and their role in improving patient outcomes and reducing the overall healthcare burden,” authors concluded.
