Chronic obstructive pulmonary disease (COPD) affects millions of Canadians and adults around the world. Acute events in COPD, called exacerbations, are associated with significant morbidity, mortality, and health care expenditures. While these acute exacerbations can be treated with short-acting inhalers, oral corticosteroids, and antibiotics, daily use of maintenance inhalers can help reduce their frequency and severity. The 3 general categories of maintenance inhalers include long-acting β2 agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroids (ICS). Historically, guidelines have recommended a step-wise approach in which patients experiencing mild to moderate COPD should start with maintenance therapy with LABA or LAMA alone and, should that therapy be inadequate, add on additional inhaled therapies (up to LABA/LAMA/ICS triple therapy). However, evidence-based guidelines now recommend starting patients with moderate to severe COPD and a low exacerbation risk on LABA/LAMA combination therapy and those at high risk of exacerbation on ICS/LABA/LAMA combination therapy, though most drug plan programs currently require patients to fail monotherapy before reimbursing combination therapy.
It is necessary to conduct a utilization study describing how long-acting inhaled COPD maintenance therapies have been (and continue to be) prescribed across Canada. We will first identify patients’ initial long-acting inhaled COPD therapies (LABA, LAMA, LABA/LAMA, LABA/ICS, LAMA/ICS, and LABA/LAMA/ICS) and describe their characteristics and how use of each type of initial therapy has changed over calendar time. We will then track how patients’ therapy choice changes, track how patients’ step-up or step-down, when they discontinue therapy, and the frequency of exacerbations over the course of patients’ first 4 “lines” of treatment. We will also describe differences between these treatment trajectories between 2012-2017 and 2018-2024