Figures
- FIGURE 1
Distribution of blood eosinophil counts for Cohorts 1 and 2.
- FIGURE 2
Adjusted hazard ratio for hospital admission within 6 weeks by blood eosinophil counts on the day of exacerbation for patients treated with oral corticosteroids for COPD exacerbations in a primary-care setting (Cohort 1). Patients categorised to eight eosinophil count categories as compared with a reference category of blood eosinophil counts 50 cells·µL−1–<150 cells·µL−1. BEC: blood eosinophil counts.
- FIGURE 3
Association between hospital admission within 6 weeks and individual change in blood eosinophil counts from an exacerbation-free period to the day of exacerbation for patients treated with oral corticosteroids for COPD exacerbations in a primary-care setting (Cohort 1). BEC: blood eosinophil counts.
- FIGURE 4
Adjusted hazard ratio for hospital readmission within 4 weeks by blood eosinophil counts during an exacerbation-free period in the prior year for patients hospitalised due to COPD exacerbations (Cohort 2). BEC: blood eosinophil counts.
- FIGURE 5
Adjusted hazard ratio for hospital readmission within 4 weeks by baseline characteristics for patients hospitalised due to COPD exacerbations (Cohort 2). a) Predictors; b) baseline moderate or severe exacerbations; c) modified Medical Research Council (mMRC) dyspnoea score; d) forced expiratory volume in 1s (FEV1) % predicted. BMI: body mass index. #: triple therapy consisted of inhaled corticosteroids, long-acting β2-agonists and long-acting muscarinic antagonists.
Tables
- TABLE 1
Demographics and baseline patient characteristics for patients treated with oral corticosteroids for COPD exacerbations in a primary-care setting (Cohort 1) and in a hospital setting (Cohort 2)
Variable Cohort 1 Cohort 2 Subjects 6416 10 245 Age years 71.3±10.3 75.1±9.9 ≥40–<60 years 850 (13.2) 716 (7.0) ≥60–<80 years 4113 (64.1) 5838 (57.0) ≥80 years 1453 (22.6) 3691 (36.0) Male 3011 (46.9) 5258 (51.3) Smoking status# Nonmissing 6364 (99.2) 10,169 (99.3) Never-smoker 747 (11.7) 993 (9.8) Current smoker 2044 (32.1) 2940 (28.9) Ex-smoker 3573 (56.1) 6236 (61.3) BMI# kg·m−2 27.6±6.1 26.0±6.2 Nonmissing 1769 (27.6) 8943 (87.3) <18.5 kg·m−2 331 (5.4) 766 (8.6) ≥18.5–<25 kg·m−2 2045 (33.1) 3596 (40.2) ≥25–<30 kg·m−2 1948 (31.5) 2495 (27.9) ≥30 kg·m−2 1855 (30.0) 2086 (23.3) Active asthma¶ 866 (13.5) 486 (4.7) Active rhinitis¶ 114 (1.8) 493 (4.8) Active eczema¶ 267 (4.2) 430 (4.2) Nasal polyps+ 133 (2.1) 147 (1.4) Diabetes mellitus+ 1132 (17.6) 1881 (18.4) GORD+ 1426 (22.2) 2044 (20.0) Cardiovascular disease+ 3001 (46.8) 6414 (62.6) Hypertension+ 3019 (47.1) 4886 (47.7) Osteoporosis+ 695 (10.8) 1241 (12.1) Depression/anxiety+ 2713 (42.3) 4396 (42.9) FEV1 % pred 53.9±20.1 50.9±20.9 Subjects 5873 7883 ≥80% pred 637 (10.8) 771 (9.8) ≥50%–<80% pred 2734 (46.6) 2901 (36.8) ≥30%–<50% pred 1776 (30.2) 3046 (38.6) <30% pred 726 (12.4) 1165 (14.8) GOLD group Subjects 5460 8789 A 838 (15.3) 556 (6.3) B 768 (14.1) 701 (8.0) C 1827 (33.5) 3641 (41.4) D 2027 (37.1) 3891 (44.3) Data are presented as n, mean±sd or n (%), unless otherwise stated. BMI: body mass index; GORD: gastro-oesophageal reflux disease; FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease. #: the closest BMI within 10 years of the index date, and the smoking status closest to and within 5 years of index date were included; ¶: active disease was defined as a diagnostic or monitoring read code or evidence for specific treatment within 1 year before index date; +: ever diagnosed.
- TABLE 2
Treatment failure overall and for patients with or without inhaled corticosteroid (ICS) prescriptions in the baseline year for patients treated with oral corticosteroids (OCS) for COPD exacerbations in a primary-care setting (Cohort 1) and patients hospitalised due to COPD exacerbations (Cohort 2)
Outcome Population size n Failure overall Failure with ICS Failure without ICS p-value ICS versus no ICS Cohort 1 (n=2482) Overall treatment failure# 2482¶ 1103 (44.4) 914 (45.0) 189 (42.0) 0.250 Hospital admission for COPD 2482¶ 255 (10.3) 218 (10.7) 37 (8.2) 0.113 OCS repeat prescription 6416 2187 (34.1) 1752 (34.6) 435 (32.3) 0.118 Antibiotic prescription 6416 623 (9.7) 525 (10.4) 98 (7.3) 0.001 Cohort 2 (n=10 245) Hospital readmission 10 245 1189 (11.6) 986 (11.9) 203 (10.5) 0.084 Data are presented as n (%) unless otherwise stated. HES: Hospital Episode Statistics. #: overall treatment failure for patients with HES linkage; treatment failure was defined as a COPD-related hospital admission or accident and emergency department visit, prescription for antibiotics with lower respiratory consultation or a repeat prescription for OCS. ¶: patients with HES linkage.
- TABLE 3
Predictors of treatment failure (hospital admission for patients treated with oral corticosteroids for COPD exacerbation in a primary-care setting (Cohort 1), hospital readmission for patients hospitalised due to COPD exacerbations (Cohort 2))
Predictor Cohort 1 Cohort 2 HR (95% CI) p-value HR (95% CI) p-value Subjects n 2482 10 245 Blood eosinophil count per 100-cells·µL−1 increase 0.26 (0.12–0.56) <0.001 0.78 (0.63–0.96) 0.020 Male 1.53 (1.19–1.98) 0.001 1.15 (1.03–1.29) 0.016 Age per 10 years 1.24 (1.17–1.32) <0.001 Underweight, BMI <18.5 kg·m−2 2.29 (1.53–3.43) <0.001 1.41 (1.17–1.70) <0.001 Smoking habits Current smoker 1.74 (1.04–2.91) 0.034 Ex-smoker 1.66 (1.02–2.71) 0.042 Cardiovascular disease 2.18 (1.61–2.95) <0.001 COPD exacerbations per 1 increase 1.12 (1.07–1.17) <0.001 1.09 (1.06–1.12) <0.001 mMRC dyspnoea scale score Maximum score 1.69 (1.05–2.70) 0.030 1.28 (1.06–1.55) 0.012 Missing# 1.25 (1.06–1.48) 0.008 FEV1 % pred <30% 1.36 (1.15–1.62) <0.001 Missing# 1.26 (1.09–1.45) 0.008 Triple therapy¶ prescribed 1.19 (1.05–1.34) 0.005 HR: hazard ratio; BMI: body mass index; mMRC: modified Medical Research Council; FEV1: forced expiratory volume in 1 s.#: patients without monitoring data; ¶: triple therapy consisted of inhaled corticosteroids, long-acting β2-agonists and long-acting muscarinic antagonists.
Supplementary Material
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Supplementary material 00188-2020.SUPPLEMENT
