Characteristics and real-world health clinical outcomes of uncontrolled COPD patients: population-based study in France

Abstract

Background COPD is often managed with triple therapy (long-acting β2-agonist, long-acting anticholinergic and inhaled corticosteroid). However, some patients experience COPD exacerbations and persistent symptoms, indicating poor disease control. This study aimed to describe the characteristics of uncontrolled COPD patients and assess clinical burden by comparing overall survival and exacerbation frequency between uncontrolled and controlled COPD patients, and between uncontrolled COPD patients and the general population. Methods This retrospective study included patients >40 years old, treated with triple therapy for ⩾90 consecutive days in 2015, from the French National Health Data System. Patients were followed for up to 5 years. COPD patients were classified as uncontrolled (one or more severe, or two moderate exacerbations within 12 months before inclusion) or controlled. A random sample from the general population was included. Propensity score matching (1:2 for uncontrolled versus general population, 1:1 for uncontrolled versus controlled) was used. Overall survival was estimated using the Kaplan–Meier method; exacerbation risks were assessed using the Kalbfleisch and Prentice method. Results Of 186 963 COPD patients on triple therapy, 21.3% (n=39 847) had uncontrolled COPD. Uncontrolled patients had a shorter overall survival and higher mortality risk compared with controlled patients (hazard ratio (HR) 1.21, 95% CI 1.18–1.23) and the general population (HR 2.51, 95% CI 2.45–2.57). Median time to first exacerbation was 0.39 years for uncontrolled versus 1.80 years for controlled patients. Discussion This study demonstrates the high clinical burden of uncontrolled COPD, defined by persistent exacerbations and characterised by reduced survival and frequent exacerbations despite triple therapy.