Abstract
This epidemiological study aimed to describe and compare the characteristics and outcomes of COPD patients starting treatment with a long-acting anti-muscarinic (LAMA) or a combination of a long-acting beta-2 agonist (LABA)/LAMA in primary care in Catalonia (Spain) over a one-year period. Data were obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database containing information of 5.8 million inhabitants (80% of the population of Catalonia). Patients initiating treatment with a LAMA or LABA/LAMA in 2015 were identified, and information about demographic and clinical characteristics was collected. Then, patients were matched 1:1 for age, sex, FEV1%, history of exacerbations, history of asthma and duration of treatment, and the outcomes between the two groups were compared. During 2015, 5729 individuals with COPD started treatment with a LAMA (69.8%) or LAMA/LABA (30.2%). There were no remarkable differences between groups except for a lower FEV1 and more previous hospital admissions in individuals on LABA/LAMA. The number of tests and referrals was low and decreased in both groups during follow-up. For the same severity status, the evolution was similar with a reduction in exacerbations in both groups. Treatment was changed during follow-up in up to 34.2% of patients in the LABA/LAMA and 26.3% in the LAMA group, but adherence was equally good for both. Our results suggest that initial therapy with LAMA in monotherapy may be adequate in a significant group of mild to moderate patients with COPD and a low risk of exacerbations managed in primary care.
Highlights
The aim of pharmacological treatment in chronic obstructive pulmonary disease (COPD) is to reduce symptoms, decrease the frequency and severity of exacerbations and improve exercise tolerance.[1]
Most studies assessing the efficacy of double bronchodilation compared with monotherapy have included moderate to severe patients with dyspnoea according to the modified Medical Research Council ≥ 2 scale,[2,7,8] excluding milder patients who may not present a significant improvement with the addition of a second long-acting bronchodilators (LABD)
The results of this study show that COPD patients starting treatment with a long-acting anti-muscarinic agents (LAMA) or a long-acting beta-2 agonist (LABA)/LAMA in the primary care setting had no remarkable differences in clinical characteristics except in regard to disease severity; patients initially treated with the combination of bronchodilators had a lower FEV1 and a greater number of previous hospital admissions
Summary
The aim of pharmacological treatment in chronic obstructive pulmonary disease (COPD) is to reduce symptoms, decrease the frequency and severity of exacerbations and improve exercise tolerance.[1]. New treatments for COPD have been launched, most being LABD, inhaled corticosteroids (ICS) and combinations of the two, with the objective of improving patient outcomes in COPD. There is a lack of follow-up studies in real life in primary care investigating the effectiveness of LABD and its combination with other agents in the usual clinical practice. The objective of this study was to describe the characteristics and outcomes of COPD patients starting inhaled treatment with a LAMA or a combination of LABA/LAMA in primary care in Catalonia (Spain) over a 1 year period
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