Study probes COPD mortality among people living in low- and middle-income countries

The data broadly matches findings in high-income countries, with males and people with low body weight at particularly high mortality risk.

A new report enriches the scientific community’s understanding of how chronic obstructive pulmonary disease (COPD) affects patients in low- and middle-income countries.

COPD is an increasingly common disease and is the subject of numerous scientific studies. However, as the authors of a new study note, most research on COPD focuses on populations in high-income countries.

“For this reason, it is particularly important to understand the survival and factors associated with survival of patients with COPD in these countries,” they wrote. Frontiers of Big Data.

Investigators used a Brazilian national health database to retrospectively follow a cohort of patients who received care for COPD between 2003 and 2015. The database yielded 37,938 patients, of whom 11,452 were matched based on sex, age and year of entry into treatment in order to assess the impact of particular therapies on survival. The mean follow-up was 37.8 months for the overall cohort and 37.7 months for the matched cohort. The mean age of the patients was 65.2 and 64.8 years, respectively.

The data showed that after one year, 97.6% (95% CI, 97.4%-97.8%) had survived. After one decade, survival was 83.1% (95% CI, 81.9% to 84.3%).

A few factors seemed to increase the risk of death: being male, being over 65, and being underweight. The authors said these results were broadly consistent with existing data, noting that low body mass index (BMI) affects 25-40% of COPD patients and is considered a poor prognostic factor.

“Malnutrition is a well-recognized risk factor for mortality in patients with COPD at all stages of the disease, and BMI is one of the 4 criteria of the BODE index (body mass index, obstruction of the airways, dyspnea, and exercise capacity) for mortality,” they wrote.

The authors said their data underscores the importance of nutritional care programs.

In terms of treatment regimens, the authors said some of the latest therapies for COPD are not universally available in Brazil. They noted that previous research has suggested that inhaled corticosteroids (ICS) along with an ultra-long-acting beta-2-agonist (LABA) are more effective than the individual components. Yet existing data also suggests that approximately 70% of COPD patients are treated with an ICS and only about half of patients with a new diagnosis are started on a fixed-dose LABA/ICS combination.

“Our study showed that this proportion is even higher, which may have occurred due to the narrow treatment options available in [Brazil’s health system]“, said the authors.

In the new analysis, patients taking a free-dose bronchodilator with a fixed-dose combination of a corticosteroid and a bronchodilator appeared to be the most protected against mortality compared to the other regimens.

The researchers discussed a number of limitations to their research. For one thing, it does not include data on new drugs, patients with private insurance, or patients in other types of subsidized drug programs. They added that they incorporated data from secondary databases, which could have affected the quality of their data.

However, as the debate continues over which therapies are best for which patients, the authors said these data for people in low- and middle-income countries are an important piece of the puzzle.

Reference

Gargano LP, Zuppo IF, do Nascimento MMG, et al. Survival analysis of patients with COPD in a 13-year national cohort study of the Brazilian National Health System. Big Data before. Published online February 7, 2022. doi:10.3389/fdata.2021.788268

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