Characteristics of COPD Vary Among Different Demographics and Smoking Statuses

Posters presented at the ATS 2021 International Conference highlighted some of the key differences in clinical characteristics associated with patients with chronic obstructive pulmonary disease (COPD) based on geography, demographics, and smoking status.

Variances in Demographics and Clinical Characteristics

One poster presentation¹ demonstrated the heterogeneity in demographic and clinical characteristics of patients with COPD treated in the United States. The investigators identified underlying factors that contribute to disparities across US health systems.

The observational study used patient data collected from the COPD Optimum Patient Care Research DARTNet Research Database, which included information on patients managed in 5 large primary care medical groups in New York (n = 1149), North Carolina (n = 6038), Ohio (n = 8722), Colorado (n = 472), and Texas (n = 811).

The electronic health record data was extracted for December 2019 to January 2020. Patients were included if they had a COPD diagnosis code, received care in a primary care facility, and were aged 35 or older at the time of receiving their COPD diagnosis.

Disparities among age, race and ethnicity, exacerbation frequency, treatment patterns, and comorbidity prevalence were observed among states. Texas had the greatest prevalence of Hispanic patients, prescription rates (45.6%) for combination therapy of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA), and diabetes (65.2%).

Ohio had a large Black COPD population and the highest prevalence (32.9%) of combination therapy featuring an ICS, a LABA, and a long-acting muscarinic antagonist. New York had the most exacerbations and the greatest prevalence of hypertension (87.9%) and asthma (61.6%).

Colorado had a predominately White COPD population, the fewest exacerbations in the past year, and the greatest prevalence of depression (86.9%). North Carolina had the oldest COPD population, the lowest comorbidity burden, and most patients reported no exacerbations in the past 12 months.

“The information creates opportunities to investigate the causes of these differences in order to assist healthcare stakeholders improve and standardize COPD care,” said presenter Wilson Pace, MD, FAAFP, professor of Family Medicine at the University of Colorado, Denver and the director of the American Academy of Family Physicians National Research Network.

Key Differences Between Smokers and Nonsmokers

In another poster,² investigators looked that the differences in clinical characteristics of patients with both COPD and asthma based on smoking status.

The cross-sectional observational study was conducted from July 1, 2003, to December 31, 2019. Out of 426 patients screened at the asthma and COPD clinic at UC Davis Health, 158 patients were identified to have an asthma and COPD overlap.

Smokers, categorized as patients who have smoked for 10 or more pack-years, accounted for 100 patients. The other 58 were categorized as nonsmokers (smoked less than 10 pack-years).

Compared with nonsmokers, the presence of emphysema (23.53% vs 48.39%) and values (mean [SD]) for total cholesterol (176.58 [49.03] vs 193.15 [44.53]) and low-density lipoprotein cholesterol (99.35 [36.34] vs 113.57 [38.64]) were higher among smokers.

For lung function values, smokers had higher values of total lung capacity and residual volume than nonsmokers. Rates of coronary artery disease were also more prevalent among smokers (43.00% vs 29.30%).

Nonsmokers had significantly higher levels of biologic therapy utilization (25.86% vs 9.00%) and diffusing capacity for carbon monoxide than smokers. Autoimmune diseases were also more prevalent among nonsmokers (19.00% vs 8.00%).

The investigators said that the higher prevalence of biologic use could represent a higher prevalence of allergic and/or type 2 inflammatory phenotypes among nonsmokers with COPD and asthma.

“Further research is needed to better characterize this understudied non-smoking [asthma and COPD overlap] sub-population to help identify the mechanistic drivers leading to airway obstruction so that targeted therapies can be developed,” said presenter Andrew Matthys, MD, a 2021 fellow for the Department of Internal Medicine at UC Davis Health.

References

1. Pace WD, Edwards C, Brandt E, et al. Variation in demographic and clinical characteristics of COPD patients managed in U.S. primary care: Data from a real-life COPD registry. Presented at: ATS 2021 International Conference; May 14-19, 2021. Poster TP39.
2. Matthys AS, Zumba JT, Wilson M, Zeki AA. Asthma COPD overlap: Key differences between smokers and non-smokers. Presented at: ATS 2021 International Conference; May 14-19, 2021. Poster TP120.