At 4 years since COPD diagnosis, patients without treatment common

Key takeaways:

• The assessed COPD population included those with commercial insurance, Medicaid Managed Care or Medicare Advantage.
• In patients who did receive treatment, the most prescribed form has been deemed “not optimal.”

When diagnosed with COPD, 86.2% of patients did not receive treatment, and after 4 years, 63.8% still had not been treated, according to results published in BMC Pulmonary Medicine.

“There is an urgent need to identify and diagnose COPD patients,” Antonio Anzueto, MD, MS, PhD, professor of medicine and section chief of pulmonary at South Texas Veterans Healthcare System, told Healio.

“[Additionally,] once patients are diagnosed, the initial treatment must be long-active bronchodilators and not inhaled corticosteroids/long-acting beta-agonist,” Anzueto continued.

Patients with an indication for ICS should be on triple therapy, Anzueto said.

In a retrospective, noninterventional study, Anzueto and colleagues analyzed 238,158 individuals (mean age, 63.8 years; 52.9% women) newly diagnosed with COPD in 2015 to 2021 with commercial insurance (29.1%), Medicaid Managed Care (46.2%) or Medicare Advantage (37.3%) to track moderate and severe exacerbation occurrence and treatment decisions in the 4 years after diagnosis.

For 6.5% of the population, insurance type was unknown, according to the study.

Researchers found reports of at least one moderate or severe exacerbation between diagnosis and the 4-year mark for 32.9% of the population.

A greater proportion of patients had moderate vs. severe exacerbations (25.8% vs. 13.8%).

As time passed from diagnosis, researchers noted a reduction in the proportion of patients with a moderate exacerbation (year 1, 43.2%; year 4, 30.8%) and a severe exacerbation (year 1, 41.8%; year 4, 27%).

When evaluating the proportion of untreated patients, this value was high at diagnosis (86.2%) and continued to be elevated at the 4-year mark (63.8%), which Anzueto told Healio was unexpected.

When divided into those prescribed a short-acting treatment at diagnosis (n = 96,258), those treated by the end of year 1 (n = 205,177) and those treated by the end of year 4 (n = 157,896), LABA/ICS was the treatment option given to the highest proportion of patients in each group, according to the study. LAMA came in second in these groups, followed by LAMA/LABA.

In the group of patients treated with a maintenance therapy at diagnosis, LABA/ICS was prescribed more than the other options (62%), according to researchers.

“Current guidelines suggest that this treatment is not optimal for most patients and that the LAMA + LABA combination is the preferred approach, offering advantages in terms of efficacy and tolerability,” Anzueto and colleagues wrote.

Further, over the course of the study period, researchers reported that high proportions of patients received LABA/ICS (year 1, 63.7%; year 2, 60.4%; year 3, 58.8%; year 4, 58.8%), whereas small proportions of patients received LAMA/LABA (year 1, 9.1%; year 2, 14.5%; year 3, 16.4%; year 4, 15.9%).

“It is important to have observations, non-intervention real-world evidence studies that will help to understand the diagnosis and management of chronic lung conditions like COPD,” Anzueto told Healio. “Future studies need to focus on the long-term impact of appropriate diagnosis and treatment in COPD patients.

“COPD is a treatable condition, [and] early diagnosis and appropriate interventions can change the course of the disease,” Anzueto added.