Treatment evolution after COPD diagnosis in the UK primary care setting

• Published in: PloS one Vol. 9; no. 9; p. e105296
• Main Authors: Wurst, Keele E, Punekar, Yogesh Suresh, Shukla, Amit
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.09.2014; Public Library of Science (PLoS)
• Subjects: Acetylcholine receptors (muscarinic); Aged; Antagonists; Asthma; Biology and Life Sciences; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical medicine; Corticoids; Corticosteroids; Demography; Diagnosis; Disease prevention; Drug Prescriptions; Drug therapy; Epidemiology; Family physicians; Female; Follow-Up Studies; Health care; Humans; Identification methods; Lung diseases; Maintenance; Male; Medical diagnosis; Medicine and Health Sciences; Obstructive lung disease; Patients; Primary care; Primary Health Care; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; R&D; Research & development; Therapy; United Kingdom; United Kingdom > UK; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0105296

To assess the treatment progression during the 24 months following a formal diagnosis of chronic obstructive pulmonary disease (COPD) in the UK primary care setting. A retrospective cohort of newly diagnosed COPD patients was identified in the Clinical Practice Research Datalink (CPRD) from 1/1/2008 until 31/12/2009. Maintenance therapy prescribed within the first 3 months of diagnosis and in the subsequent 3-month intervals for 24 months were analyzed. Treatment classes included long-acting β2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids (ICSs), and respective combinations. At each 3-month interval, discontinuation, switching, addition, and stepping down patterns were analyzed cumulatively for the first 12 months and over the 24-month of follow-up. A total of 3199 patients with at least one prescription of a maintenance therapy at baseline and during 4th-6th month interval were included in the analysis. At diagnosis (0-3 months), the most frequently prescribed maintenance therapy was LABA+ICS (43%), followed by LAMA (24%) and LABA+LAMA+ICS (23%). Nearly half the patients (LABA-50%, LAMA-43%) starting on a monobronchodilator had additions to their treatment in 24 months. Compared to other medications, patients starting on a LAMA were most likely to escalate to triple therapy in 24 months. Nearly one-fourth of the patients prescribed triple therapy at baseline stepped down to LABA+ICS (25%) or LAMA (31%) within 24 months. Disease progression is evident over the 24 months after COPD diagnosis, as more patients were prescribed additional maintenance therapy in the 24-month period compared to baseline. The changes in therapy suggest that it is difficult to achieve a consistently improved COPD disease state.