Older age, multiple comorbidities frequent in patients starting inhaled COPD therapy

Key takeaways:

• When divided into five age groups, higher proportions of patients fell in the older vs. younger groupings.
• Uncomplicated hypertension was the No. 1 reported comorbid condition at 77%.

BOSTON — Among adults with COPD starting a new inhaled maintenance treatment, common characteristics included older age and having multiple comorbidities, according to a poster presented at the CHEST Annual Meeting.

“This study confirms that patients with COPD are often older patients with significant comorbidity burden, with most having [greater than or equal to] five comorbid conditions,” Vickram Tejwani, MD, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine and staff physician at Cleveland Clinic, and colleagues wrote on the poster.

Tejwani and colleagues assessed 211,449 adults (mean age, 71 years; 51% women; mean Elixhauser score, 6) with COPD starting a new inhaled maintenance treatment via Optum’s Clinformatics Data Mart database of U.S. individuals on Medicare or commercial insurance plans to gain real-world knowledge on the demographics and clinical characteristics of this population.

When divided into five age groups, higher proportions of patients fell in the groupings of 60 to 69 years (30%), 70 to 74 years (21%) and 75 years and older (36%) vs. the younger groupings of 50 to 59 years (11%) and 40 to 49 years (2%).

Most of the total cohort was white (74%), with a lower proportion of African American patients (12%), Hispanic patients (7%) and Asian patients (2%). The race/ethnicity for the remaining 6% was unknown, according to the poster.

Of the two insurance types, Medicare was the reported plan for more patients than commercial (86% vs. 14%).

Nearly half (47%) of the study population was from the South, followed by the West (21%), the Midwest (21%) and the Northeast (12%).

When asked about tobacco, 69% of the total cohort reported use.

In terms of comorbidities, 59% belonged to the Elixhauser score group signaling the presence of at least five comorbidities, according to the poster. Smaller proportions of patients had four comorbidities (13%), three comorbidities (13%), two comorbidities (11%) and one comorbidity (5%).

Uncomplicated hypertension was the No. 1 reported comorbid condition at 77%. Other frequent conditions highlighted on the poster included cardiac arrhythmias (33%), peripheral vascular disorders (33%), uncomplicated diabetes (30%) and depression (29%).

Of the various maintenance treatments observed, the starting combination of long-acting beta-2 agonist/inhaled corticosteroid was reported by the highest proportion of patients at 47%.

“LABA/ICS was the most commonly prescribed initial inhaled maintenance treatment, despite newer recommendations that discourage use,” Tejwani and colleagues wrote on the poster.

Additionally, 19% reported starting long-acting muscarinic antagonist, 18% reported starting LABA/LAMA and 12% reported starting LAMA/LABA/ICS in a single inhaler. Researchers noted low proportions of patients being prescribed LABA (1%) or LAMA/LABA/ICS in multiple inhalers (3%).

Compared with primary care physicians, nurse practitioners and other professionals (classified as “non-specialists”), pulmonologists were behind fewer prescriptions for each initial treatment: LABA/ICS (78% vs. 12%), LAMA (74% vs. 17%), LABA/LAMA (62% vs. 32%), LAMA/LABA/ICS in a single inhaler (66% vs. 27%), LABA (69% vs. 19%) and LAMA/LABA/ICS in multiple inhalers (64% vs. 17%).

“Given patients with COPD have multiple comorbid conditions, complexity of overall care is increased,” Tejwani and colleagues wrote.