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Abstract：
BACKGROUND: Prompt and effective management with maintenance therapy (single or dual bronchodilator therapy) is recommended after the initial diagnosis of chronic obstructive pulmonary disease (COPD) to maintain lung function and prevent exacerbations. Contrary to guideline-based recommendations, most patients are not prescribed maintenance treatment at initial diagnosis. The current study assessed the pharmacologic treatment patterns and outcomes of newly diagnosed patients with COPD in the USA.
METHODS: This retrospective, noninterventional study used de-identified data from the Inovalon Insights\' database (Commercial, Medicaid Managed Care, and Medicare Advantage-insured individuals) between January 1, 2015, and December 31, 2021. The \"patient journey\" from initial diagnosis was followed over a 4-year period. The primary outcome measure was the number of moderate or severe exacerbations. Secondary outcome measures included the cumulative incidence of exacerbations, mean cumulative count of moderate and severe exacerbations, rates of moderate and severe exacerbations in patients who remained untreated after diagnosis in 12-month time periods for 4 years, sociodemographic and clinical characteristics, and pharmacologic treatment patterns.
RESULTS: The cohort consisted of 238,158 newly diagnosed patients with COPD (female [52.9%]; mean age 63.8 years). The majority of patients with COPD had Medicaid as their primary insurance (46.2%). Overall, during the 4-year follow-up period, 32.9% of the patients had at least one moderate or severe exacerbation, and 25.8% and 13.8% experienced moderate and severe exacerbations, respectively. At diagnosis, 86.2% of the patients were untreated and most remained untreated by the end of the follow-up (63.8%). Most patients (62.0%) received long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) as their initial treatment at diagnosis, and LABA/ICS continued to be the most common initial treatment during the 4-year period (64.0% at year 1; 58.0% at year 4).
CONCLUSIONS: Most patients with COPD were not treated at initial diagnosis and remained untreated during follow-up. Our data highlight a lack of adherence to recommendations for clinical practice.
METHODS: This retrospective, noninterventional study used de-identified data from the Inovalon Insights\' database (Commercial, Medicaid Managed Care, and Medicare Advantage-insured individuals) between January 1, 2015, and December 31, 2021. The \"patient journey\" from initial diagnosis was followed over a 4-year period. The primary outcome measure was the number of moderate or severe exacerbations. Secondary outcome measures included the cumulative incidence of exacerbations, mean cumulative count of moderate and severe exacerbations, rates of moderate and severe exacerbations in patients who remained untreated after diagnosis in 12-month time periods for 4 years, sociodemographic and clinical characteristics, and pharmacologic treatment patterns.
RESULTS: The cohort consisted of 238,158 newly diagnosed patients with COPD (female [52.9%]; mean age 63.8 years). The majority of patients with COPD had Medicaid as their primary insurance (46.2%). Overall, during the 4-year follow-up period, 32.9% of the patients had at least one moderate or severe exacerbation, and 25.8% and 13.8% experienced moderate and severe exacerbations, respectively. At diagnosis, 86.2% of the patients were untreated and most remained untreated by the end of the follow-up (63.8%). Most patients (62.0%) received long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) as their initial treatment at diagnosis, and LABA/ICS continued to be the most common initial treatment during the 4-year period (64.0% at year 1; 58.0% at year 4).
CONCLUSIONS: Most patients with COPD were not treated at initial diagnosis and remained untreated during follow-up. Our data highlight a lack of adherence to recommendations for clinical practice.
摘要：
背景：建议在初次诊断为慢性阻塞性肺疾病（COPD）后，及时有效地进行维持治疗（单或双支气管扩张剂治疗），以维持肺功能并防止加重。与基于准则的建议相反，大多数患者在初次诊断时没有接受维持治疗.本研究评估了美国新诊断的COPD患者的药物治疗模式和结果。
方法：本回顾性研究，非介入研究使用InovalonInsights数据库中的去识别数据(商业，医疗补助管理式护理，和MedicareAdvantage保险的个人)在2015年1月1日至2021年12月31日之间。从最初诊断开始的“患者旅程”持续了4年。主要结果指标是中度或重度加重的次数。次要结果指标包括加重的累积发生率，中度和重度加重的平均累积计数，在4年的12个月时间内，诊断后仍未治疗的患者的中度和重度加重率，社会人口统计学和临床特征，和药物治疗模式。
结果：队列包括238,158例新诊断的COPD患者（女性[52.9%]；平均年龄63.8岁）。大多数COPD患者将医疗补助作为其主要保险（46.2％）。总的来说,在4年的随访期间，32.9％的患者至少有一次中度或重度加重，25.8%和13.8%出现中度和重度加重,分别。诊断时,86.2％的患者未经治疗，大多数患者在随访结束时仍未治疗（63.8％）。大多数患者（62.0％）在诊断时接受长效β-激动剂（LABA）/吸入糖皮质激素（ICS）作为初始治疗，在4年期间,LABA/ICS仍然是最常见的初始治疗(第1年为64.0%;第4年为58.0%)。
结论：大多数COPD患者在初次诊断时未接受治疗，随访期间仍未接受治疗。我们的数据突出表明缺乏对临床实践建议的依从性。
方法：本回顾性研究，非介入研究使用InovalonInsights数据库中的去识别数据(商业，医疗补助管理式护理，和MedicareAdvantage保险的个人)在2015年1月1日至2021年12月31日之间。从最初诊断开始的“患者旅程”持续了4年。主要结果指标是中度或重度加重的次数。次要结果指标包括加重的累积发生率，中度和重度加重的平均累积计数，在4年的12个月时间内，诊断后仍未治疗的患者的中度和重度加重率，社会人口统计学和临床特征，和药物治疗模式。
结果：队列包括238,158例新诊断的COPD患者（女性[52.9%]；平均年龄63.8岁）。大多数COPD患者将医疗补助作为其主要保险（46.2％）。总的来说,在4年的随访期间，32.9％的患者至少有一次中度或重度加重，25.8%和13.8%出现中度和重度加重,分别。诊断时,86.2％的患者未经治疗，大多数患者在随访结束时仍未治疗（63.8％）。大多数患者（62.0％）在诊断时接受长效β-激动剂（LABA）/吸入糖皮质激素（ICS）作为初始治疗，在4年期间,LABA/ICS仍然是最常见的初始治疗(第1年为64.0%;第4年为58.0%)。
结论：大多数COPD患者在初次诊断时未接受治疗，随访期间仍未接受治疗。我们的数据突出表明缺乏对临床实践建议的依从性。
