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. 2025 Jun 16;11(3):00976-2024.
doi: 10.1183/23120541.00976-2024. eCollection 2025 May.

Unmet needs of patients with COPD in Germany: a retrospective, cross-sectional study

Felix J F Herth  1   2 , Claus F Vogelmeier  2   3 , Franziska C Trudzinski  1   2 , Henrik Watz  2   4   5 , Dirk Skowasch  6 , Kai-Michael Beeh  7 , Chris Compton  8 , Tharishini Mohan  8 , Hartmut Richter  9 , Jing Claussen  10 , Sabine Bartel  10
Affiliations

Unmet needs of patients with COPD in Germany: a retrospective, cross-sectional study

Felix J F Herth et al. ERJ Open Res. .

Abstract

Background: Earlier diagnosis and treatment of COPD, particularly preventing exacerbations, are key to slowing disease progression and reducing mortality. This study focused on the identification of patients in Germany with unstable COPD due to suboptimal treatments.

Methods: The IQVIA™ LRx database, capturing 80% of Statutory Health Insurance prescriptions was used to identify patients with COPD using a machine-learning model. Patients with unstable COPD were identified through high prescriptions of oral corticosteroid (OCS) and/or rescue inhalers between April 2022 and March 2023.

Results: The machine-learning model identified around 2.6 million treated patients with COPD, with 77% precision. The mean age was 71 years, 48% were female and 86% were aged ≥60 years. About 14% patients (n=363k) exhibited unstable COPD due to high OCS prescriptions, while 10% patients (n=256k) had high rescue inhaler prescriptions. Among those with high OCS and high rescue inhaler prescriptions, respectively, 43% and 38% were on dual therapy, 17% and 21% were on single inhaler triple therapy, 14% and 16% were on multiple inhaler triple therapy, 11% and 9% were on monotherapy and 15% and 17% had no maintenance therapy.

Conclusions: A substantial number of unstable COPD patients were either on suboptimal maintenance therapy (monotherapy or inhaled corticosteroid-based dual therapy) or not receiving any maintenance therapy. The study highlights a substantial need in Germany for improved maintenance therapy, which could reduce disease burden, improve disease stability and reduce reliance on OCS and rescue therapies, thereby minimising side effects.

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Conflict of interest statement

Conflict of interest: F.J.F. Herth received grants or contracts from the German Ministry of Education and Science (BMBF), AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GSK, Grifols and Novartis; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, CSL Behring, Chiesi, GSK, Insmed, Menarini, Novartis, Roche, Sanofi, Olympus and Pulmonx; and is an associate editor of this journal. Conflict of interest: C.F. Vogelmeier received grants or contracts from BMBF, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GSK, Grifols and Novartis; consulting fees from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GSK, Insmed, Menarini, Novartis, Nuvaira and Sanofi; and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GSK, Insmed, Menarini, Novartis, Roche and Sanofi. Conflict of interest: F.C. Trudzinski received all support for the present manuscript from GSK; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Novartis AG, GSK, Chiesi, Boehringer Ingelheim GmbH, Grifols, CSL Behring, Streamed Up, RG Gesellschaft für Information and Organisation GmbH and AstraZeneca; support for attending meetings and/or travel from Grifols and CSL Behring. Conflict of interest: H. Watz received grants or contracts from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, EpiEndo, Bristol Myers Squibb and Roche; consulting fees, payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events, support for attending meetings and/or travel from AstraZeneca, Boehringer Ingelheim, Chiesi and GSK; and participated on a data safety monitoring or advisory board for AstraZeneca, Boehringer Ingelheim, Chiesi and GSK. Conflict of interest: D. Skowasch received all support for the present manuscript from GSK; grants or contracts from Boehringer Ingelheim, BMBF and DFG; consulting fees from GSK, AstraZeneca, Sanofi, Janssen and MSD; and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from GSK, AstraZeneca, Sanofi, Janssen, MSD, Chiesi and Boehringer Ingelheim. Conflict of interest: K-M. Beeh received consulting fees from GSK, Clario, Berlin Chemie, Chiesi, Sanofi and Bosch Healthcare; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from GSK, Berlin Chemie, Chiesi, Sanofi, Novartis, Orion Pharma and Hormosan; and participated on a data safety monitoring or advisory board for Clario and Chiesi. Conflict of interest: C. Compton, J. Claussen and T. Mohan hold financial equities in GSK and are employees of GSK. Conflict of interest: H. Richter is an employee of IQVIA GmbH & Co OHG; IQVIA were contracted and paid by GSK to make the data available and conduct the analyses. Conflict of interest: S. Bartel is an employee of GSK, holds financial equities in GSK and has received all support for the present manuscript from GSK GmbH & Co KG.

Figures

FIGURE 1
FIGURE 1
Prediction of diagnosis by a machine-learning model based on prescriptions. EMR: electronic medical record; ICS: inhaled corticosteroid; LABA: long-acting β2-agonist; LRx: Longitudinal Prescription database; LTRA: leukotriene receptor antagonist; SHI: statutory health insurance.
FIGURE 2
FIGURE 2
Identification of patients with COPD from IQVIA™ Longitudinal Prescription database (LRx). M: million.
FIGURE 3
FIGURE 3
a) Patients with COPD by dominant maintenance therapy, b) patients with unstable COPD by high oral corticosteroid (OCS) use or high rescue inhaler use, c) patients with unstable COPD with both high OCS use and high rescue inhaler use. ICS: inhaled corticosteroid; k: thousand; LABA: long-acting β2-agonist; LAMA: long-acting muscarinic antagonist; MITT: multiple inhaler triple therapy; SABA: short-acting β2-agonist; SITT: single inhaler triple therapy. #: monotherapy includes LABA or LAMA; ICS-based dual therapies include ICS/LABA, ICS+LABA or ICS+LAMA; dual therapy LABA/LAMA includes LABA/LAMA or LABA+LAMA; SITT includes ICS/LABA/LAMA; MITT includes IC+LABA+LAMA, ICS+LABA/LAMA or ICS/LABA+LAMA.
FIGURE 4
FIGURE 4
Treatment patterns in patients with unstable COPD with high oral corticosteroid (OCS) prescriptions. a) Proportion of patients with unstable COPD with high OCS prescriptions, b) dominant maintenance therapies of patients (×1000) with unstable COPD with high OCS prescriptions, c) number of patients with unstable COPD with high OCS prescriptions (>2 per year) and d) distribution of levels of high OCS prescriptions (>500 mg prednisone equivalents over 12 months) within each dominant COPD maintenance therapy. ICS: inhaled corticosteroid; k: thousand; LABA: long-acting β2-agonist; LAMA: long-acting muscarinic antagonist; MITT: multiple inhaler triple therapy; OCS: oral corticosteroid; SITT: single inhaler triple therapy. #: ICS-based dual therapies include ICS/LABA, ICS+LABA or ICS+LAMA; dual therapy LABA/LAMA includes LABA/LAMA or LABA+LAMA; SITT includes ICS/LABA/LAMA; MITT includes ICS+LABA+LAMA, ICS+LABA/LAMA or ICS/LABA+LAMA.
FIGURE 5
FIGURE 5
Treatment patterns in patients with unstable COPD with high rescue inhaler prescriptions. a) Proportion of patients with unstable COPD with high rescue inhaler use, b) dominant maintenance therapies of patients with unstable COPD with high rescue inhaler use (patients, ×1000). ICS: inhaled corticosteroid; k: thousand; LABA: long-acting β2-agonist; LAMA: long-acting muscarinic antagonist; MITT: multiple inhaler triple therapy; SITT: single inhaler triple therapy. #: ICS-based dual therapies include ICS/LABA, ICS+LABA or ICS+LAMA; dual therapy LABA/LAMA includes LABA/LAMA or LABA+LAMA; SITT includes ICS/LABA/LAMA; MITT includes ICS+LABA+LAMA, ICS+LABA/LAMA or ICS/LABA+LAMA.
FIGURE 6
FIGURE 6
Treatment patterns in patients with unstable COPD with both high oral corticosteroid (OCS) prescriptions and high rescue inhaler prescriptions. a) Proportion of patients with unstable COPD with high rescue inhaler use, b) dominant maintenance therapies of patients (×1000) with unstable COPD with high rescue inhaler use. ICS: inhaled corticosteroid; k: thousand; LABA: long-acting β2-agonist; LAMA: long-acting muscarinic antagonist; MITT: multiple inhaler triple therapy; SITT: single inhaler triple therapy. #: ICS-based dual therapies include ICS/LABA, ICS+LABA or ICS+LAMA; dual therapy LABA/LAMA includes LABA/LAMA or LABA+LAMA; SITT includes ICS/LABA/LAMA; MITT includes ICS+LABA+LAMA, ICS+LABA/LAMA or ICS/LABA+LAMA.
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