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Characterization of Patients with COPD and GOLD E Classification in the United States
Surya P Bhatt1, Yiran Zhang2, John White2
1Department of Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Background:
The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) update reclassified patients with chronic obstructive pulmonary disease (COPD) into group E based solely on exacerbation history, regardless of symptom burden. However, there are limited real-world descriptions of these patients at high risk of future exacerbation. This study therefore characterized patients in GOLD E, including subgroups based on blood eosinophil count (BEC), triple inhaler therapy use, and smoking status.
Methods:
Retrospective analysis of administrative claims and electronic health records obtained from Optum's Market Clarity Dataset between 2016 and 2021. Adults aged 40-80 years with COPD and continuous enrollment were observed for three years. Year 1 (baseline) included the earliest evidence of COPD. GOLD E status was defined as ≥ 2 moderate or ≥ 1 severe exacerbation during baseline.
Results:
Of 145,341 patients with COPD, 38,648 (26.6%) met GOLD E criteria. Patients in GOLD E had a higher prevalence of comorbidities (including cardiovascular-related conditions), elevated BEC (≥ 300 cells/μL), triple inhaler use, and former smoking status, compared with non-GOLD E. Approximately 58.2% of patients in GOLD E had evidence of a BEC test. Despite treatment recommendations, only 14.2% of patients in GOLD E with elevated BEC used triple inhalers. Notably, 34.8% of GOLD E had no evidence of any maintenance medication use. Of those with known smoking status (65.6%), current smokers had fewer severe exacerbations than never or former smokers. However, current smokers were 4.5-5.5 years younger, had lower prevalences of obesity and cardiovascular comorbidities, and the highest use of rescue medications-factors that help explain this unexpected result.
Conclusion:
Many patients in the United States with COPD in GOLD E were not treated according to recommendations, and BEC testing remains underutilized. Exacerbation rates were high, even among never or former smokers with COPD.
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