Patients with newly diagnosed chronic obstructive pulmonary disease in the United States were untreated with long-acting maintenance therapy at diagnosis, according to a recent study.
In the retrospective cohort study, published in BMC Pulmonary Medicine, investigators analyzed treatment patterns and outcomes among patients newly diagnosed with chronic obstructive pulmonary disease (COPD) in the United States. The analysis utilized de-identified administrative claims data from the Inovalon Insights’ database spanning 2015 to 2021. The study aimed to assess adherence to guideline-directed therapy and its association with exacerbation rates over 4 years.
The study included 238,158 patients (mean age = 63.8 years, 52.9% female), with most insured through Medicaid Managed Care (46.2%). At diagnosis, 86.2% of the patients were untreated with long-acting maintenance therapy, and the majority (63.8%) remained untreated by the end of the 4-year follow-up. Among treated patients, long-acting beta-agonist (LABA) and inhaled corticosteroid combinations were the most common initial therapy, accounting for 62.0% of prescriptions at diagnosis and 58.0% after 4 years. Dual bronchodilation with LABA and long-acting muscarinic antagonist, recommended in recent guidelines, was prescribed less frequently.
During the follow-up period, 32.9% of patients experienced at least one exacerbation, with moderate exacerbations (25.8%) occurring more frequently compared with severe exacerbations (13.8%). Exacerbation rates peaked in the first year postdiagnosis at 0.15 per person-year for moderate exacerbations and 0.07 per person-year for severe exacerbations. Rates declined progressively over time. Patients who remained untreated exhibited lower exacerbation rates compared with those who initiated therapy (0.08 vs 0.23 per person-year in year 1), likely reflecting differences in baseline disease severity.
The findings indicated that adherence to evidence-based treatment guidelines could be improved, particularly in primary care settings where most patients are initially managed. The study documented a reliance on short-acting beta-agonists and underutilization of recommended maintenance therapies.
Limitations included the inability to assess clinical severity directly and the potential for misclassification. The study indicated that optimizing COPD management may reduce exacerbations and improve patient outcomes. Additional research is needed to understand factors influencing the implementation of guideline-directed care in real-world settings.
Full disclosures can be found in the published study.
