title: Treatment evolution after COPD diagnosis in the UK primary care setting.
abstract: BACKGROUND
  To assess the treatment progression during the 24 months following a formal diagnosis of chronic obstructive pulmonary disease (COPD) in the UK primary care setting.
  
  
  METHODS
  A retrospective cohort of newly diagnosed COPD patients was identified in the Clinical Practice Research Datalink (CPRD) from 1/1/2008 until 31/12/2009. Maintenance therapy prescribed within the first 3 months of diagnosis and in the subsequent 3-month intervals for 24 months were analyzed. Treatment classes included long-acting β2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids (ICSs), and respective combinations. At each 3-month interval, discontinuation, switching, addition, and stepping down patterns were analyzed cumulatively for the first 12 months and over the 24-month of follow-up.
  
  
  RESULTS
  A total of 3199 patients with at least one prescription of a maintenance therapy at baseline and during 4th-6th month interval were included in the analysis. At diagnosis (0-3 months), the most frequently prescribed maintenance therapy was LABA+ICS (43%), followed by LAMA (24%) and LABA+LAMA+ICS (23%). Nearly half the patients (LABA-50%, LAMA-43%) starting on a monobronchodilator had additions to their treatment in 24 months. Compared to other medications, patients starting on a LAMA were most likely to escalate to triple therapy in 24 months. Nearly one-fourth of the patients prescribed triple therapy at baseline stepped down to LABA+ICS (25%) or LAMA (31%) within 24 months.
  
  
  CONCLUSIONS
  Disease progression is evident over the 24 months after COPD diagnosis, as more patients were prescribed additional maintenance therapy in the 24-month period compared to baseline. The changes in therapy suggest that it is difficult to achieve a consistently improved COPD disease state.
authors.affiliation: Worldwide Epidemiology, GlaxoSmithKline R&D, Research Triangle Park, North Carolina, United States of America.
authors.forename: Keele E
authors.initials: KE
authors.lastname: Wurst
authors.affiliation: Global Health Outcomes, GlaxoSmithKline R&D, Uxbridge, Middlesex, United Kingdom.
authors.forename: Yogesh Suresh
authors.initials: YS
authors.lastname: Punekar
authors.affiliation: Worldwide Epidemiology, GlaxoSmithKline R&D, Upper Providence, Pennsylvania, United States of America.
authors.forename: Amit
authors.initials: A
authors.lastname: Shukla
mesh_terms: D000368:Aged; D003710:Demography; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy*; D006113:United Kingdom