The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK

Susan C. Edwards, Sian E. Fairbrother, Anna Scowcroft, Gavin Chiu, Andrew Ternouth, Brian J. Lipworth (Lead / Corresponding author)

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Abstract

Background: This study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burden, measured by health care utilization.

Methods: Data were extracted from the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients' rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.

Results: A cohort of 8,811 COPD patients (95% Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45% of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).

Conclusion: The average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids.

Original languageEnglish
Pages (from-to)2851-2858
Number of pages8
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Volume11
Issue number1
DOIs
Publication statusPublished - 22 Nov 2016

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Chronic Obstructive Pulmonary Disease
Maintenance
Prescriptions
Bronchodilator Agents
Adrenergic Agonists
Muscarinic Antagonists
Delivery of Health Care
Disease Progression
Adrenal Cortex Hormones
Patient Acceptance of Health Care
Hospitalization
Therapeutics
Referral and Consultation

Keywords

  • COPD
  • UK primary care setting
  • Bronchodilators
  • Prescribing patterns
  • Monotherapy

Cite this

Edwards, Susan C. ; Fairbrother, Sian E. ; Scowcroft, Anna ; Chiu, Gavin ; Ternouth, Andrew ; Lipworth, Brian J. / The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK. In: International Journal of Chronic Obstructive Pulmonary Disease. 2016 ; Vol. 11, No. 1. pp. 2851-2858.
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abstract = "Background: This study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burden, measured by health care utilization.Methods: Data were extracted from the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients' rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.Results: A cohort of 8,811 COPD patients (95{\%} Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45{\%} of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).Conclusion: The average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids.",
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note = "This study was sponsored by Boehringer Ingelheim International GmbH. Writing and editorial assistance was provided by Lisa Buttle, PhD, of Ascot Medical Communications Consultancy and Vidula Bhole, MD, MHSc, of Cactus Communications, which were contracted by Boehringer Ingelheim International GmbH for these services. A poster entitled “Current COPD disease burden associated with maintenance monotherapy in the UK”, which included the preliminary results from this study, has been presented at the British Thoracic Society Winter Meeting, London, UK; December 3–5, 2014.",
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The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK. / Edwards, Susan C.; Fairbrother, Sian E.; Scowcroft, Anna; Chiu, Gavin; Ternouth, Andrew; Lipworth, Brian J. (Lead / Corresponding author).

In: International Journal of Chronic Obstructive Pulmonary Disease, Vol. 11, No. 1, 22.11.2016, p. 2851-2858.

Research output: Contribution to journalArticle

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T1 - The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK

AU - Edwards, Susan C.

AU - Fairbrother, Sian E.

AU - Scowcroft, Anna

AU - Chiu, Gavin

AU - Ternouth, Andrew

AU - Lipworth, Brian J.

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Y1 - 2016/11/22

N2 - Background: This study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burden, measured by health care utilization.Methods: Data were extracted from the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients' rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.Results: A cohort of 8,811 COPD patients (95% Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45% of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).Conclusion: The average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids.

AB - Background: This study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burden, measured by health care utilization.Methods: Data were extracted from the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients' rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.Results: A cohort of 8,811 COPD patients (95% Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45% of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).Conclusion: The average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids.

KW - COPD

KW - UK primary care setting

KW - Bronchodilators

KW - Prescribing patterns

KW - Monotherapy

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DO - 10.2147/COPD.S109707

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JO - International Journal of Chronic Obstructive Pulmonary Disease

JF - International Journal of Chronic Obstructive Pulmonary Disease

SN - 1176-9106

IS - 1

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