Clinical Profile of Patients with Chronic Obstructive Pulmonary Disease from a Portuguese Integrated Health Care Unit: A Real-World Study
DOI:
https://doi.org/10.24950/rspmi.2789Keywords:
Pulmonary Disease, Chronic Obstructive/epidemiology, Pulmonary Disease, Chronic Obstructive/drug therapyAbstract
Introduction: Clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) in Portugal were mainly examined in studies with small sample sizes from either primary or secondary care. The integrated analysis of primary and secondary care data reflecting daily clinical practice has yet to be explored.
We aimed to comprehensively describe the clinical characteristics of patients with COPD within an unselected population of a Portuguese Integrated Health Care Unit across two periods.
Methods: This is a real-world, retrospective, observational study that used healthcare data of the Local Health Unit of Matosinhos. Two COPD cohorts were analysed: an incident cohort, from January 1, 2013, to December 31, 2018; and a prevalent cohort, established as of December 31, 2021. Individuals ≥40 years, diagnosed with COPD and with 1 year of history prior to diagnosis were identified. Data regarding age, sex, exacerbations, comorbidities and COPD medication were analysed. Moderate exacerbations were defined as COPD-related outpatient visits requiring respiratory antibiotics, and/or oral systemic corticosteroids within a 7 days window, while severe exacerbations included emergency room visits or hospitalizations. COPD medications were categorized based on the Anatomical Therapeutic Chemical Classification System.
Results: In the incident analysis (2013–2018), 5,696 COPD cases were identified (median age 68.0 [IQR 18.0] years; 68% male), while the 2021 prevalent cohort included 3,457 patients (median age 71.0 [IQR 17.0] years; 69.3% male). More than half of the patients experienced at least one moderate or severe exacerbation (2013-2018 59.7%, 2021 76.7%) and more than one-third (2013-2018 36.9%, 2021 49.6%) had severe exacerbations. The combination of long-acting β-2 agonists (LABA) or long-acting anticholinergics (LAMA) plus inhaled corticosteroids (ICS) (2013-2018 23.2%, 2021 36.1%) were the most common inhaler prescriptions. Triple combination therapy (ICS+LABA+LAMA) in free combinations was prescribed to around 10% of patients (2013-2018 9.1%; 2021 10.0%), while in fixed-dose combination was marginally prescribed (2013-2018 0.1%, 2021 1.7%). Almost half of the 2013-2018 incident cohort (49.6%) and a quarter of the 2021 prevalent cohort (24.7%) received no inhaled medication.
Conclusion: Our findings offer valuable insights into the clinical profile of patients with COPD, their exacerbation history, and treatment patterns. These findings underscore the need for comprehensive, targeted and integrated interventions for this population.
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