Patient Preferences for COPD Maintenance Therapies in the United States

Background: COPD affects about 14.2 million (6.5%) of U.S. adults and incurred about $49B in 2020 US healthcare costs. Despite wide availability of diverse pharmacological treatment, including nebulized and handheld, adherence to COPD treatment is low, and patient preferences can influence treatment use. There is a need to better understand patient preferences in COPD and integrate patient perspectives into COPD management strategies. Methods: This was a qualitative study using online focus groups for patients with moderate-to-severe COPD on maintenance therapy. Semi-structured interview guides were used for two patient groups (n = 6, n = 7) and one caregiver group (n = 5) to elucidate personal experience and factors influencing perceptions of medication delivery devices. This study received approval from Advarra IRB (study Pro00079092). Results: Among patients, 6 (46%) were male and average age was 72.1. Eight were diagnosed >10 years earlier. Six patients used inhaler only and another 6 used both inhaler and nebulizer as part of their maintenance regimen. Overall, effectiveness was most frequently cited (n = 4) as an important attribute of treatment. Three patients cited that their treatment cost was a challenge (inhaler = 2, oxygen = 1). Six (46%) patients said that reducing dose frequency was important. While all expressed involvement of healthcare providers in treatment choices, 6 (46%) said the choice was ultimately theirs. For inhalers, portability was cited as an advantage (n = 2), while requiring device adjustment (spacer) (n = 5) and triggering cough due to powder (n = 4) were the most frequently reported difficulties. Current nebulizer users found their treatment to be ‘effective’ (n = 2) and ‘fast-acting’ (n = 1), while portability (n = 3) and time consumption (n = 4) were cited as disadvantages. Among caregivers, 3 (60%) were female and average age was 55. All caregivers reported playing a supportive role in gathering information [GL1] [SH2], and overall expressed similar advantages/disadvantages about treatments as the patients. These results are the precursor for 1:1 concept elicitation interviews and a planned discrete choice experiment (DCE) to quantify patient trade-offs. Conclusions: Several factors, such as effectiveness, dose frequency, cost, and portability can play a key role in COPD treatment decisions and regular use of maintenance therapy. Further research is planned to examine how these preferences impact COPD management.