Prevalence and healthcare utilization of eosinophilic chronic obstructive pulmonary disease in the UK: an observational electronic health record-based cohort study

Abstract Background Biologic therapies offer new treatment opportunities for patients with eosinophilic COPD. However, the number and proportions of patients with COPD who would be eligible are unknown. Methods Using data from Optimum Patient Care Research Database, we conducted a retrospective observational study of electronic health records (EHR) from UK primary care practices. We determined the prevalence and number of patients with eosinophilic COPD and of patients with potential eligibility for biologic therapy under different eligibility criteria. We further interrogated EHR to classify risk factors and health outcomes during a 1-year follow-up period. Results The study population comprised 6,601,051 patients from 727 primary care practices. 40,840 (0.62%) patients had eosinophilic COPD on 1 January, 2024. Of these, 1117 (0.017%) would have been eligible for biologics therapy if eligibility criteria were ≥ 2 exacerbations when treated with triple therapy in the previous year and no concurrent asthma; 419 (0.006%) would have been eligible if eligibility criteria were ≥ 3 exacerbations. During follow-up, patients with ≥ 3 exacerbations on triple therapy in the previous year had greater hazard of all-cause mortality (adjusted 1-year cumulative incidence = 18.5% compared to 7.6%; HR = 2.5, 95% CI 2.0–3.3), of all-cause hospitalization (adjusted 1-year cumulative incidence = 57.5% compared to 33.2%; HR = 2.3, 95% CI 2.0–2.7) and a significantly increased number of exacerbations. Conclusions Less than a third of COPD-patients have eosinophilic COPD but with eligibility criteria requiring triple therapy and at least 2 exacerbations, the number of patients who would be eligible for biologics therapy is small.