Abstract
IntroductionTo address the burden of chronic obstructive pulmonary disease (COPD), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends treatment according to classification of patients by symptom severity and exacerbation risk. This post hoc analysis of a previously reported claims-linked, cross-sectional survey [study 205862 (HO-16-16642)] classified patients with COPD receiving long-acting muscarinic antagonist (LAMA) monotherapy based on the GOLD 2017 categories.MethodsEligible patients who were ≥ 40 years of age, with ≥ 2 claims with International Classification of Diseases-10th Revision-Clinical Modification COPD diagnosis codes J40–J44 ≥ 30 days apart during the 12-month baseline period, and ≥ 2 claims for LAMA monotherapy in the 6 months prior to identification, were identified using claims data from the Optum Research Database. Patients completed a survey assessing modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT) scores and demographics; clinical characteristics were assessed from claims and survey data, while exacerbation history was assessed from claims data. GOLD symptom severity classifications were low (groups A and C) for patients with low scores on both the CAT and mMRC scales (scores of < 10 and 0–1, respectively), and high (groups B and D) for patients with high scores on either scale (scores of ≥ 10 and 2–4, respectively).ResultsOf 433 patients included, 85.5% reported a CAT total score ≥ 10, and 45.5% reported mMRC grades 2–4. During the baseline period, 63.7% of patients had ≤ 1 moderate and 0 severe (hospitalized) exacerbations, and 36.3% had ≥ 1 severe or ≥ 2 moderate exacerbation(s). The proportions of patients with each GOLD classification were: A: 9.0%; B: 54.7%; C: 4.6%; D: 31.6%.ConclusionsIn this population, over 85% of LAMA monotherapy users have symptoms and/or exacerbation risk that may necessitate therapy escalation according to 2017 GOLD guidelines.FundingGlaxoSmithKline [study 205862 (HO-16-16642)].
Highlights
To address the burden of chronic obstructive pulmonary disease (COPD), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends treatment according to classification of patients by symptom severity and exacerbation risk
Patients completed a survey assessing modified Medical Research Council Dyspnea Scale and COPD Assessment Test (CAT) scores and demographics; clinical characteristics were assessed from claims and survey data, while exacerbation history was assessed from claims data
The proportions of patients with each GOLD classification were: A: 9.0%; B: 54.7%; C: 4.6%; D: 31.6%. In this population, over 85% of long-acting muscarinic antagonist (LAMA) monotherapy users have symptoms and/ or exacerbation risk that may necessitate therapy escalation according to 2017 GOLD guidelines
Summary
To address the burden of chronic obstructive pulmonary disease (COPD), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends treatment according to classification of patients by symptom severity and exacerbation risk. This post hoc analysis of a previously reported claims-linked, cross-sectional survey [study 205862 (HO-1616642)] classified patients with COPD receiving long-acting muscarinic antagonist (LAMA) monotherapy based on the GOLD 2017 categories. Since 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report has included treatment recommendations that are stratified by patient classifications based on assessment of symptom severity and exacerbation risk [7, 8]. Patients are categorized into GOLD groups A, B, C, or D using scores from patient-reported outcome (PRO) measures [the modified Medical Research Council (mMRC) Dyspnea Scale or the COPD Assessment Test (CAT)], and moderate/severe exacerbation history, as follows: GOLD A, low symptom severity and low exacerbation risk; GOLD B, high symptom severity and low exacerbation risk; GOLD C, low symptom severity and high exacerbation risk; and GOLD D, high symptom severity and high exacerbation risk [7, 8]
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