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. 2014 Sep 2;9(9):e105296.
doi: 10.1371/journal.pone.0105296. eCollection 2014.

Treatment evolution after COPD diagnosis in the UK primary care setting

Keele E Wurst  1 , Yogesh Suresh Punekar  2 , Amit Shukla  3
Affiliations

Treatment evolution after COPD diagnosis in the UK primary care setting

Keele E Wurst et al. PLoS One. .

Abstract

Rationale: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

Competing Interests: Funding for this study was provided by GlaxoSmithKline and all authors are employees of GlaxoSmithKline. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Maintenance prescriptions at diagnosis.
Patients (n = 3199) prescribed maintenance therapy at baseline and 3–6 months excluding patients with no treatment, SABD alone, ICS, and others. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 2
Figure 2. Proportions of patients continuing on the same treatment class for 24 months.
a To be included in analysis, patients had to receive a prescription at each 3-month interval. Triple, LABA+LAMA+ICS. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 3
Figure 3. Percentage of changes in maintenance medications at the end of the 24 months of follow-up.
Censored indicates no prescription for a COPD maintenance medication during a 3 month interval.
See this image and copyright information in PMC

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