BREZTRI is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).1
For your symptomatic patients with COPD,
Start Protecting
with BREZTRI
COPD is a leading cause of death worldwide
COPD, chronic obstructive pulmonary disease. a50%-75% for services associated with exacerbations.8
1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. http://goldcopd.org. Accessed April 2021; 2. Diab N et al. Am J Respir Crit Care Med. 2018;198:1130-1139; 3. Ford ES et al. Chest. 2015;147:31-45; 4. Chen X et al. Int J COPD. 2016;11:2625-2632; 5. Nishimura S et al. Respirology. 2004;9:466-473; 6. Qureshi H et al. Ther Adv Chronic Dis. 2014;5:212-227; 7. Press VG et al. Curr Opin Pulm Med. 2018;24:138-146; 8. Celli BR et al. Eur Respir J. 2004;23:932-946; 9. Toy EL et al. COPD. 2010;7:214-228; 10. Anzueto A. Eur Respir Rev. 2010;19:113-118; 11. Geitona M et al. Respir Med. 2011;105:402-409; 12. Perera PN et al. COPD. 2012;9:131-141; 13. World Health Organization. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed April 2021.
Exacerbations are frequently unreported by patients
aDefinitions differ slightly between studies; bEurope refers to Bulgaria, Czech Republic, Hungary, Poland, Romania, and Slovakia;
cMultinational refers to Australia, Canada, Germany, Japan, Korea, Philippines, Poland, Russia, Slovakia, Taiwan, Ukraine, US.
1. Leidy NK et al. Ann Am Thorac Soc. 2014;11:316-325; 2. Langsetmo L et al. Am J Respir Crit Care Med. 2008;177:396-401;
3. Xu W et al. Eur Respir J. 2010;35:1022-1030; 4. Wilkinson TM et al. Am J Respir Crit Care Med. 2004;169:1298-1303.
The majority of patients with COPD will experience an exacerbation
ECLIPSE, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; SPIROMICS, Subpopulations and Intermediate Outcome Measures in COPD Study; UPLIFT, Understanding Potential Long-term Impacts on Function with Tiotropium.
1. Hurst JR et al. N Engl J Med. 2010;363:1128-1138; 2. Han MK et al. Lancet Respir Med. 2017;5:619-626; 3. Tashkin DP et al. N Engl J Med. 2008;359:1543-1554.
The best predictor of an exacerbation is a prior history of exacerbations
Figure adapted from Müllerová H et al. BMJ Open. 2014;4:e006171. aRetrospective observational cohort study that evaluated risk factors associated with exacerbation frequency in 58,589 patients with COPD identified in the UK Clinical Practice Research Datalink.
1. Müllerová H et al. BMJ Open. 2014;4:e006171; 2. Hurst JR et al. N Engl J Med. 2010;363:1128-1138.
Patients with a high symptom burden are at greater risk of exacerbations
MRC, Medical Research Council. Figure adapted from Müllerová H et al. BMJ Open. 2014;4:e006171. aLindberg et al. studied 1986 individuals (993 with COPD and 993 controls without lung function impairment) to evaluate the impact of productive cough on exacerbations and mortality. bRetrospective observational cohort study that evaluated risk factors associated with exacerbation frequency in 58,589 patients with COPD identified in the UK Clinical Practice Research Datalink.
1. Müllerová H et al. BMJ Open. 2014;4:e006171; 2. Lindberg A et al. Respir Med. 2015;109:88-95.
Patients with comorbid conditions are at increased risk of having frequent exacerbations1
CI, confidence interval; GERD, gastroesophageal reflux disease.
aRetrospective cohort study based on 2012-2013 electronic health records from 179 Dutch general practices (N=14,603); selected comorbidities associated with ≥2 exacerbations per year versus <2 exacerbations per year in patients with COPD, corrected for age and sex.
1. Westerik JA et al. Respir Res. 2017;18:31.
Lung function decline following an exacerbation is greatest in patients with mild COPD1
Figure adapted from Dransfield MT et al. Am J Respir Crit Care Med. 2017;195:324-330. aData on the first 2000 patients who returned for a second visit in the COPDGene study 5 years after enrolment were evaluated to determine the association between acute COPD exacerbations and FEV1 decline in all GOLD stages.
bExacerbations were defined as acute respiratory symptoms requiring either antibiotics or systemic steroids, and severe events by the need for hospitalisation.
1. Dransfield MT et al. Am J Respir Crit Care Med. 2017;195:324-330.
Lung function may not fully recover after an exacerbation
FEV1, forced expiratory volume in 1 second.
Figure adapted from Watz H et al. Respir Res. 2018;19:251. aA post hoc analysis of the WISDOM study in 317 patients with severe to very severe COPD to characterise lung function before, during, and after a moderate COPD exacerbation.
1. Watz H et al. Respir Res. 2018;19:251.
Damage from exacerbations goes beyond the lungs
CV, cardiovascular; MI, myocardial infarction; THIN, The Health Improvement Network.
aA case-series study conducted in 25,857 patients with COPD to assess the magnitude and timing of the risk of MI and stroke following a COPD exacerbation from those entered in THIN database in England and Wales over a 2-year period. bRisk of MI doubled within 5 days and returned to baseline over time. cNot statistically significant. dModerate exacerbations were defined by prescription of oral steroids (except fludrocortisone) and prescription of preselected oral antibiotics commonly used in treating exacerbations.
1. Donaldson GC et al. Chest. 2010;137:1091-1097.
Moderate exacerbations are associated with an increased risk of hospitalisation or death1a
Figure adapted from Rothnie KJ et al. Am J Respir Crit Care Med. 2018;198:464-471. aModerate exacerbations defined as those managed outside hospital and severe as those requiring hospitalisation. bA total of 99,574 patients with COPD were identified from the UK Clinical Practice Research Datalink to investigate the natural history of COPD exacerbations over 10 years of follow-up. cBased on adjusted ORs for comparison of exacerbation frequency in the prior 12 months vs. those with no exacerbations in the prior 12 months. dBased on adjusted HRs for comparison of a future severe exacerbation in patients with one previous moderate exacerbation vs those without an exacerbation during a case-control study.
1. Rothnie KJ et al. Am J Respir Crit Care Med. 2018;198:464-471.
Severe exacerbations are associated with increased mortality
LHID, Longitudinal Health Insurance Database. Figure adapted from Ho TW et al. PLoS One. 2014;9:e114866. aData generated in populations located in Taiwan, US, and Spain. bA population-based cohort study in 4204 patients with COPD who had their first-ever exacerbation requiring hospitalisation was conducted to describe the in-hospital and 1-year outcomes from the LHID in Taiwan. cExacerbation requiring hospitalisation.
1. Ho TW et al. PLoS One. 2014;9:e114866; 2. Lindenauer PK et al. Am J Respir Crit Care Med. 2018;197:1009-1017; 3. Garcia-Sanz MT et al. J Thorac Dis. 2017;9:636-645.
A combination of treatment approaches is required for optimal prevention of exacerbations
LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist. aMeta-analysis of 14 trials published between 2007 and 2018.
1. Au D et al. J Gen Intern Med. 2009;24:457-463; 2. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. http://goldcopd.org. Accessed April 2021; 3. Ryrsø CK et al. BMC Pulm Med. 2018;18:154; 4. Cazzola M et al. Eur Respir J. 2018;52:1801586; 5. Donaire-Gonzalez D et al. Eur Respir J. 2015;46:1281-1289; 6. Zwerink M et al. Cochrane Database Syst Rev. 2014;19:CD002990; 7. Garrastazu R et al. Arch Bronconeumol. 2016;52:88-95; 8. Wilson R et al. J Infect. 2013;67:497-515; 9. Ringbaek TJ et al. Eur Respir J. 2002;20:38-42.
The current global treatment paradigm for managing exacerbations is one of stepwise treatment escalation
aGraph is an illustration of a typical journey for a patient with COPD experiencing exacerbations.
1. Dransfield MT et al. Am J Respir Crit Care Med. 2017;195:324-330; 2. Watz H et al. Respir Res. 2018;19:251; 3. GOLD. Global strategy for the diagnosis, management, and prevention of COPD: 2020 report. Accessed April 2021.
Y1-0900