The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.
The decline in exacerbations of chronic obstructive pulmonary disease (COPD) during the COVID-19 pandemic has complicated clinicians’ ability to identify frequent exacerbators on the basis of prior-year exacerbation frequency. To address this issue, researchers tested the alternative approach of using the prior 2 years of exacerbation history, instead of a single year, as a basis for predicting the frequency of future COPD exacerbations. Findings of this research were presented at the CHEST 2021 Annual Meeting, held virtually October 17 to 20.
To assess this alternative approach of using the prior 2-year COPD exacerbation history to predict future exacerbations, the investigators used US claims data from IQVIA Pharmetrics Plus for 2015-2019 to identify patients with COPD (age, ≥40 years) who were on standard-of-care combination therapy and had 1 to 3 years’ worth of follow-up data available. From this cohort of patients, researchers then created 2 comparison groups: patients with at least 2 COPD exacerbations over a 12-month period within 2 years preceding follow up (group A; n=14,972); and patients with at least 2 exacerbations during the 1 year preceding follow up (group B, a subset of group A; n=9781). The investigators defined exacerbations as COPD-related visits to the emergency room or hospital admissions and prescriptions for antibiotics or oral corticosteroid burst.
In group A, the proportions of patients with at least 2 exacerbations in years 1, 2, and 3 were 41.7%, 38.6%, and 38.0%, respectively. For group B, the proportions of patients with at least 2 exacerbations in years 1, 2, and 3 were 48.9%, 44.8%, and 43.5%, respectively. The investigators note that patients in group A had a lower exacerbation rate during follow-up (0.87 per patient-year [PY]; 95% CI, 0.86-0.88) compared with patients in group B (1.00 per PY; 95% CI, 0.99-1.01).
The proportions of the frequent exacerbator phenotype among patients with 3 years of follow-up were 38.2% for group A vs 45.6% for group B in year 1; 22.4% for group A (58.6% of year 1) vs. 28.5% group B (62.6% of year 1) in year 2; and 15.7% for group A (70.1% of year 2) vs. 20.5% group B (71.9% of year 2) in year 3.
Investigators concluded that a 2-year “exacerbation history may be an acceptable alternative to the prior-year history to guide patient management while pandemic measures continue to impact typical patient behaviors and exacerbation rates.”
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Dayal P, Dimond C, Yang X, et al. Defining the frequent exacerbator phenotype during a pandemic in COPD. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract A1786-A1787.