ERS 2022: Time to Raise Standards of Care for Patients with COPD

3 Sep - 6 Sep, 22

Barcelona

3 Sep - 6 Sep, 22

Barcelona

In this session, a panel of global experts discussed the ways to overcome the global healthcare challenge created by the burden of COPD. In addition, the session discussed the importance of identifying and phenotyping 'at-risk' patients and reducing the burden of exacerbations and preventable mortality.

The first talk focused on the need to change the current situation in COPD management. COPD is a significant healthcare burden and cause of mortality worldwide. It is the third leading cause of death worldwide, accounting for approximately 3 million deaths annually. The burden of COPD varies considerably, and low socioeconomic status may drive health inequality and disease risk. Most patients with COPD have exacerbations, and many may be unreported. COPD exacerbations can have a long-term impact on a patient's health and well-being. Exacerbations can inversely reduce lung function. Increased frequency of exacerbations increases the risk of all-cause mortality. Early detection and diagnosis of COPD are essential but are often missed. The current global treatment paradigm for the management of COPD is one of stepwise treatment escalation. Systemic corticosteroids in patients with high exacerbations are associated with the risk of various adverse outcomes.

The next talk discussed prompt identification of patients with COPD and their underlying risks. An increased frequency and severity of baseline acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with an increased risk of subsequent AECOPD. Patients with increased dyspnea are at higher risk of exacerbations. A study showed that a modified Medical Research Council (mMRC) dyspnea score >2 was associated with a significantly shorter all-cause survival. A global prospective observational study reported that frequent productive cough indicates a risk of exacerbations and disease severity. The risk of exacerbation increases with elevated blood eosinophil levels in patients not treated with inhaled corticosteroid (ICS). The impact of an exacerbation is said to go beyond the lungs. Studies have shown that myocardial infarction and stroke risk increased in the first ten days after a moderate exacerbation. A secondary analysis of the SUMMIT study showed that in patients with COPD and existing or risk factors for CVD, the risk of CV events persisted for up to a year after an exacerbation.

Early interventions can prevent exacerbations and reduce the risk of mortality. Hospitalization for an exacerbation of COPD is associated with readmission and mortality. In the UK, 38.7% of patients are readmitted or die within 90 days after an exacerbation. Following hospitalization, some patients are discharged with no maintenance therapy. An observational cohort study showed that delaying maintenance therapy was associated with increased future exacerbation risk. The PRIMUS study showed that prompt initiation of triple therapy was associated with a reduced risk of exacerbations.

In contrast, delayed initiation of triple therapy was associated with increased healthcare resource utilization. The 52-week ETHOS trial in patients with COPD found that triple therapy with budesonide/ glycopyrrolate/ formoterol resulted in a lower rate of moderate or severe COPD exacerbations than glycopyrrolate–formoterol or budesonide–formoterol. In addition, triple therapy with budesonide/glycopyrrolate/formoterol reduced the risk of all-cause mortality compared with dual therapy. GOLD 2022 reports suggest a beneficial effect of fixed-dose triple inhaler therapy in patients with symptomatic COPD with a history of frequent and/or severe exacerbations previously receiving maintenance therapy.

The last presentation discussed the quality standards in patient care to conquer COPD. Quality standards to improve the COPD care pathway include: