COPD exacerbations by disease severity in England

International Journal of COPD Dovepress open access to scientific and medical research Original Research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Open Access Full Text Article COPD exacerbations by disease severity in England This article was published in the following Dove Press journal: International Journal of COPD 1 April 2016 Number of times this article has been viewed Evie Merinopoulou 1 Mireia Raluy-Callado 1 Sreeram Ramagopalan 1 Sharon MacLachlan 1 Javaria Mona Khalid 2 Real-World Evidence, Evidera, Takeda Development Centre Europe Ltd, London, UK 1 2 Introduction Correspondence: Mireia Raluy-Callado Real-World Evidence, Evidera, Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL, UK Tel +44 20 857 65000 Fax +44 20 857 65195 Email Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by progressive airflow obstruction.1 Exacerbations of COPD, defined as the acute worsening of symptoms, contribute to the overall severity of the disease and can be an important cause of hospital admission and readmission2 leading to significant disability, decreased quality of life, and an increased risk of death. Additionally, the health care resource use associated with the management of COPD in primary and secondary care results in a substantial economic burden borne by national health care systems.3 In the UK, COPD is the most common respiratory condition with an estimated prevalence of 33 cases per 1,000 persons in 2013.4 We recently showed using UK primary care data that 26.2% of patients with COPD on December 31, 2013 had one 697 submit your manuscript | www.dovepress.com International Journal of COPD 2016:11 697–709 Dovepress © 2016 Merinopoulou et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/COPD.S100250 Powered by TCPDF (www.tcpdf.org) Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated disease progression and are important drivers of health care resource utilization. The study aimed to quantify the rates of COPD exacerbations in England and assess health care resource utilization by severity categories according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013. Methods: Data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics were used to identify patients with a COPD diagnosis aged $40 years. Those with complete spirometric, modified Medical Research Council Dyspnea Scale information, and exacerbation history 12 months prior to January 1, 2011 (index date) were classified into GOLD severity groups. Study outcomes over follow-up (up to December 31, 2013) were exacerbation rates and resource utilization (general practitioner visits, hospital admissions). Results: From the 44,201 patients in the study cohort, 83.5% were classified into severity levels GOLD A: 33.8%, GOLD B: 21.0%, GOLD C: 18.1%, and GOLD D: 27.0%. Mean age at diagnosis was 66 years and 52.0% were male. Annual exacerbation rates per person-year increased with severity, from 0.83 (95% confidence interval [CI]: 0.81–0.85) for GOLD A to 2.51 (95% CI: 2.47–2.55) for GOLD D. General practitioner visit rates per person-year also increased with severity, from 4.82 (95% CI: 4.74–4.93) for GOLD A to 7.44 (95% CI: 7.31–7.61) for GOLD D. COPD-related hospitalization rates per person-year increased from less symptoms (GOLD A: 0.28, GOLD C: 0.39) to more symptoms (GOLD B: 0.52, GOLD D: 0.84). Conclusion: Patients in the most severe category (GOLD D) experienced nearly three times the number of exacerbations and COPD-related hospitalizations as those in the least severe category (GOLD A), in addition to increased general practitioner visits. Better patient management to stabilize the disease progression could allow for an improvement in exacerbation frequency and a reduction in health care resource utilization. Keywords: COPD, exacerbation, resource use, admissions, England, GOLD 2013 Dovepress International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Merinopoulou et al exacerbation episode in the year prior to diagnosis, and 25.5% of patients had more than one episode.4 Risk factors for frequent exacerbations included disease severity measured by stages of airflow obstruction and levels of dyspnea. A retrospective analysis using the same primary care database found COPD management costs to increase with exacerbation frequency and level of dyspnea.3,5 General practitioner (GP) interactions were major cost drivers, followed by hospitalizations unrelated to COPD and exacerbations. In recent years, the assessment of COPD has evolved from defining disease severity as a function of the degree of airflow limitation to the inclusion of patient symptoms, history of exacerbations, and comorbidities.6 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy7 recognizes the importance of a combined assessment of symptom severity and risk of future events determined by exacerbation history, such as recurrent exacerbations, hospital admissions, or mortality for guiding appropriate therapy. According to GOLD 2013,7 patients with COPD can be classified into four severity categories: GOLD A (low risk, low symptoms), GOLD B (low risk, more symptoms), GOLD C (high risk, low symptoms), and GOLD D (high risk, more symptoms). More recent updates of the GOLD strategy maintained the same treatment paradigm. Given the burden of COPD encompasses acute exacerbations requiring hospitalization, it is important to assess the epidemiology and rates of COPD exacerbations and resource use across settings of care. The objectives of this study were to assess the demographic and clinical characteristics of patients with COPD, including prescribed medications; quantify the rates of exacerbations in the COPD population in the UK; and assess the resource utilization in both primary and secondary care according to the latest available at the time – GOLD 2013 severity categories. Methods Data The diagnosis and management of COPD in the UK is performed mainly by GPs in the primary care setting; however, the occurrence of acute exacerbations o (...truncated)