Healthcare, Medication Utilization and Outcomes of Patients with COPD by GOLD Classification in England

• Published in: International journal of chronic obstructive pulmonary disease Vol. 16; pp. 2591 - 2604
• Main Authors: Sansbury, Leah B, Rothnie, Kieran J, Bains, Chanchal, Compton, Chris, Anley, Glenn, Ismaila, Afisi S
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2021; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: Adrenal Cortex Hormones - therapeutic use; Aged; Aged, 80 and over; Bronchodilator Agents - adverse effects; chronic obstructive lung disease; Chronic obstructive pulmonary disease; Classification; Clinical medicine; Delivery of Health Care; Disease Progression; Dyspnea; England - epidemiology; exacerbations; Female; global initiative for chronic obstructive lung disease; Health services utilization; healthcare costs; Hospitalization; Humans; Lung diseases, Obstructive; maintenance therapy; Male; Medical care; Medical care, Cost of; Medical research; Medicine, Experimental; Middle Aged; Mortality; Muscarinic Antagonists - adverse effects; Original Research; Patient outcomes; Patients; Practice research; Prescription writing; Primary care; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; Respiratory agents; Retrospective Studies; Spirometry; United Kingdom; Utilization; England; United Kingdom; United Kingdom > UK; maintenance therapy; database; chronic obstructive lung disease; exacerbations; healthcare costs; Global Initiative for Chronic Obstructive Lung Disease
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S318969

Available data on the relationship between COPD symptoms, disease outcomes, and mortality are currently limited. This study investigated the clinical characteristics, outcomes, healthcare utilization, and prescribing practices across GOLD 2017 groups (A, B, C, and D) in a large-scale, population-based cohort of COPD patients managed in an English primary care setting. This retrospective analysis included patients aged ≥35 years, with a confirmed diagnosis of COPD and ≥1 record of pulmonary function testing in their medical history. Medical Research Council dyspnea score and exacerbation history were used to define patients' GOLD 2017 classification. Patients were identified using the UK Clinical Practice Research Database and were followed for 12 months. Eligible COPD patients' (N=42,331; mean [SD] age, 69.5 [10.7] years; 54% males), GOLD 2017 categorizations were: Group A: 49.1%, Group B: 30.5%, Group C: 8.2%, Group D: 12.1%. Overall, 37.7% of patients experienced ≥1 moderate COPD exacerbation. The rate of moderate exacerbations per person per year (PPPY) was highest in GOLD group D (0.72), followed by C (0.53), B (0.22), and A (0.15), while the rate of exacerbations leading to hospitalization PPPY was much higher in D (0.27) than in B (0.10), C (0.08), or A (0.03). Overall, 56.4% of patients visited their general practitioner ≥5 times in the 12 months of follow-up. Time-to-event analysis suggested that breathlessness contributed to exacerbation severity and frequency. One-year mortality was highest in GOLD groups D and B. The most frequent prescribed maintenance therapies were inhaled corticosteroids with long-acting β -agonists, multiple-inhaler triple therapy, or long-acting muscarinic antagonist, irrespective of GOLD classification. The burden of COPD remains substantial in England. Stratification of this large primary care population according to GOLD criteria predicted the risk of COPD exacerbations. Understanding populations of patients with COPD may enable the optimization of patient care.