The healthcare burden of non-compliance to pharmacotherapeutic escalation recommendations for COPD

To describe the healthcare burden associated with not escalating patients with COPD managed with LAMA or LABA monotherapy or LAMA/LABA dual therapy to ICS/LAMA/LABA following a moderate or severe exacerbation. This observational study utilised medical claims from the Quebec Provincial Health Insurance administrative database. Included were patients ≥40 years of age with an incident diagnosis of COPD (during 2002–2011) receiving a respiratory medicine within 2 weeks of a COPD claim and treated with a LAMA, LABA or LAMA/LABA without a preceding moderate or severe exacerbation. Multivariate-adjusted outcomes included incidence density rates for moderate or severe COPD exacerbations and healthcare utilisation, stratified by escalation to ICS/LAMA/LABA triple therapy following an exacerbation. Overall, 19,198 (49.5%) patients experienced COPD exacerbations. Of these, 1,136 (5.9%) were escalated to triple therapy following an exacerbation. Compared with patients switched to triple therapy, those not escalated experienced increased mean incidence density rates (per 100 person-years) for future exacerbations (any: 0.21 vs 0.18, p Failure to escalate to ICS/LAMA/LABA triple therapy following an exacerbation results in increased exacerbations, ER visits and concomitant medication use in patients with COPD. Funded by GSK: HO-13-14097.