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

Int J Chron Obstruct Pulmon Dis. 2021 Sep 15:16:2591-2604. doi: 10.2147/COPD.S318969. eCollection 2021.

Abstract

Background: 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.

Patients and methods: 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.

Results: 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 β2-agonists, multiple-inhaler triple therapy, or long-acting muscarinic antagonist, irrespective of GOLD classification.

Conclusion: 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.

Keywords: Global Initiative for Chronic Obstructive Lung Disease; chronic obstructive lung disease; database; exacerbations; healthcare costs; maintenance therapy.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Aged, 80 and over
  • Bronchodilator Agents / adverse effects
  • Delivery of Health Care
  • Disease Progression
  • England / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscarinic Antagonists / adverse effects
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / drug therapy
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • Retrospective Studies

Substances

  • Adrenal Cortex Hormones
  • Bronchodilator Agents
  • Muscarinic Antagonists

Grants and funding

This study was funded by GlaxoSmithKline (study number 208979). The sponsor was involved in study conception and design, data interpretation, and the decision to submit the article for publication. The sponsor was also given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.