Despite Treatment, Burden of COPD High Among Patients in US
Look at 17,000 people in primary care finds frequent comorbidities, disease flares
Despite treatment, a large number of people with chronic obstructive pulmonary disease (COPD) in the U.S. continue to experience a high symptom burden and frequent exacerbations, or episodes of sudden disease worsening, a study reported.
Findings highlight the need to better understand the real-world effectiveness of COPD management strategies in the primary care setting, which may differ from that seen in clinical trials with more stringent inclusion criteria, its scientists noted.
The study, “COPD Population in US Primary Care: Data From the Optimum Patient Care DARTNet Research Database and the Advancing the Patient Experience in COPD Registry,” was published in the journal Annals of Family Medicine.
In the U.S., about 80% of COPD patients receive most of their medical care from family doctors or general practitioners, the researchers noted, but many primary care physicians may not be familiar with COPD management guidelines, which poses a barrier to care.
Further, more systematically collected information is needed regarding the real-world effectiveness of COPD management strategies, which could differ from clinical trial findings.
COPD burden in US marked by exacerbations, symptoms and comorbidities
An international group of researchers reviewed the demographic and clinical characteristics of a large group of COPD patients being treated at primary care centers in the U.S.
Their analysis covered 17,192 patients whose medical records were in the COPD Optimum Patient Care Research DARTNet Research Database (COPD-RD). Also included were data from a smaller group of 1,354 patients in the Advancing the Patient Experience in COPD (APEX-COPD) registry, which combines medical record data from COPD-RD and links them to patient-reported information or outcomes collected during primary care visits.
Patients were seen across 31 sites in Ohio, North Carolina, New York, Texas, and Colorado.
Demographic data from the two patient groups were largely similar. In both, approximately 56% of participants were female; patients in COPD-RD had a mean age of 67.4 years and those in APEX-COPD a mean age of 69.3 years. Most were smokers or ex-smokers, and overweight or obese.
Generally, the clinical disease characteristics of APEX-COPD patients also mirrored those seen in the larger COPD-RD group.
Almost all COPD-RD patients (99%) had at least one co-existing condition, with 87% having three or more conditions. The most common comorbidities in both patient groups were high blood pressure, diabetes, depression, and arthritis.
Most COPD-RD participants (88%) were on daily medications to manage disease symptoms. In most cases (30%), this involved inhaled corticosteroids combined with a long-acting beta-agonist, or LABA. A triple combination of steroids, LABA, and a long-acting muscarinic antagonist (LAMA) were given to 27% of the patients.
Short-term rescue treatments to ease acute symptom worsening were used as the only treatment in 9% of the patients in the COPD-RD group. Only 3% of the COPD-RD patients were not on treatment in the past year.
A similar pattern was observed in APEX-COPD patients, with a slightly higher proportion (8%) not on therapy or on triple therapy (38%), and fewer on short-term rescue-only treatment (5%).
Despite treatment being given to most of these patients, 38% in the COPD-RD group and 47% in the APEX-COPD group had at least one disease exacerbation in the last year. COPD exacerbations were characterized by bronchitis, respiratory tract infection, or other respiratory symptoms requiring antibiotic and/or steroid treatments.
Patient-reported characteristics were also assessed in the APEX-COPD group. Most patients (82%) reported a medium to very high impact of COPD on their health, as measured by the COPD Assessment Test.
Nearly 10% of the patients reported a very high COPD impact score, indicating they felt that they never had a good day and could not do anything they wanted to do.
Further, 20% reported high levels of breathlessness requiring them to frequently stop for breath when walking, or breathlessness that prevented them from leaving the house.
About a third of APEX-COPD group patients (35%) were considered to be at a high risk of disease exacerbations and 31.2% reported that they continued to smoke.
Together, these findings highlight that COPD patients in the U.S. continue to experience a high rate of disease exacerbations and symptom burden, despite ongoing treatment.
This could mean that “patients are not treated appropriately or are poorly compliant,” the researchers wrote, noting that “more focus on nonpharmacological [non-drug] treatment options” may be needed to ease symptoms.
Primary care physicians might also need to be better educated in diagnosing and treating COPD earlier to prevent lung function decline, the researchers suggested.
“Taken together, these findings indicate further opportunity for medication optimization in the primary care setting for COPD patients and call for more real-life effectiveness trials, or broader inclusion criteria for [randomized controlled trials] to provide real-life evidence of response to and appropriateness of treatment and to inform COPD management guidelines,” the researchers wrote.
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