Exploring the Impact of Early Diagnosis and Treatment Initiation of Newly Diagnosed COPD Patients

<bold>Background:</bold> Chronic obstructive pulmonary disease (COPD) morbidity and mortality are increasing worldwide and also in Hungary. Early identification and treatment may help reduce the frequency and severity of COPD exacerbations. <bold>Methods:</bold> The nationwide, retrospective, financial database analysis, the EXPLORE-2 study examined the disease trajectory of newly diagnosed COPD patients between 2011 and 2019 in Hungary, focusing on the time until the first moderate (MAE) and severe exacerbation (SAE) and death. A multi-state illness-death model without recovery was used. Possible states were COPD, MAE, SAE and death, while possible transitions were 1.) COPD to MAE or SAE or death 2.) MAE to SAE or death and 3.) SAE to death. <bold>Results:</bold> Altogether 132,554 newly diagnosed COPD patients were identified between 2009-2019. Redemption for prescribed maintenance therapy for 12 continous weeks was only seen in 62,695 cases, 42.53% starting with a long-acting bronchodilator (beta-agonist – LABA/ muscarininc-antagonist – LAMA), 19.64% with LABA-LAMA, 11.03% with inhaled corticosteroids (ICS) and LABA and 5.86% triple therapy (mostly open triple). The remaining 20.95% had inconclusive therapy regimens in the first 12 weeks. The multi-state analysis revealed that patients who had been diagnosed during a MAE or SAE are at much higher risk for SAE (hazard ratio, HR=5.41 for MAE to SAE) and death (HR=4.11 for MAE to death and HR=2.29 for SAE to death). In all transitions female sex had lower risk for MAE, SAE and death, while older age and heart failure increased the risk of MAE, SAE and death. <bold>Conclusions:</bold> Our results confirmed the huge benefit of early diagnosis and the importance of starting therapy early.