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Symptomatic burden of COPD for patients receiving dual or triple therapy

Authors Chen S, Small M, Lindner L, Xu X

Received 25 January 2018

Accepted for publication 5 April 2018

Published 27 April 2018 Volume 2018:13 Pages 1365—1376


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Stephanie Chen,1 Mark Small,2 Leandro Lindner,3 Xiao Xu1,4

1Health Economics and Payer Analytics, AstraZeneca, Gaithersburg, MD, USA; 2Respiratory, Adelphi Real World, Bollington, UK; 3Global Payer Evidence and Pricing, AstraZeneca, Cambridge, UK; 4Global Payer Evidence and Pricing, AstraZeneca, Gaithersburg, MD, USA

Background: COPD is associated with a large disease burden. The use of dual (two maintenance treatments) and triple (combination of any three treatments) therapy has shown efficacy for symptom relief; however, some patients with COPD remain symptomatic despite these therapies. This study assessed the scope and magnitude of the symptomatic burden for patients with COPD receiving dual or triple therapy.
Patients and methods: Cross-sectional data from three Adelphi COPD surveys (2013–2016) conducted in the USA, Europe, Japan, and China were analyzed for patients with COPD and forced expiratory volume in 1 second ≤65% receiving dual or triple therapy for ≥3 months. Physicians completed clinical and disease characteristic forms for identified patients. Corresponding patients completed questionnaires that included validated survey instruments to assess adherence and symptom impact. Descriptive statistics are reported.
Results: Our analysis included 690 patients (mean age 68.2 years; 73.3% male); 41.4% and 58.6% were receiving dual and triple therapy, respectively. Most patients had dyspnea with substantial disability (modified Medical Research Council dyspnea scale rating ≥2, 56.3%; large health status impairment from symptoms, COPD Assessment Test score >20, 64.4%). A large symptom burden was observed, even for patients highly adherent to treatment (Morisky Medication Adherence Scale 8, 30.3% [185/612]), of whom 62.1% still had a COPD Assessment Test score >20. Sensitivity analyses of patients regardless of their forced expiratory volume in 1 second status and of those receiving treatment for >6 months both reported similar results.
Conclusion: Although patients who consult their physicians more frequently than average may be overrepresented because of the observational design of this study, we report that unmet needs remain for patients with COPD, despite the use of dual or triple therapy. A percentage of patients with COPD reported major symptom burden affecting their daily living and causing a large impairment in the health status, regardless of treatment adherence.

Keywords: COPD, burden of illness, triple therapy, dual therapy

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