The long-term clinical and economic impact of COPD exacerbations: an observational study (SHERLOCK)

Background: Exacerbations are an important driver of disease progression in COPD and are a key target for patient management. An observational retrospective cohort Study of HEalthcare Resource utiLisation related to exacerbatiOns in patients with COPD (SHERLOCK; D5980R00014) evaluated the clinical impact of exacerbations in primary care patients. Objective: To evaluate associations between exacerbation history and subsequent exacerbations in COPD. Methods: Patients in NHS Scotland ≥40 years of age with COPD were stratified by exacerbation history in the prior year: Group A (none), B (1 moderate), C (1 severe) and D (≥2 moderate and/or severe). Exacerbation rate and type were assessed over 3 years. Rate ratios (RR) were calculated versus the patients in Group A. Results: Overall, 22,462 patients were included. Over 1 year, moderate or severe exacerbation rates for the groups were 0.69 (A), 1.20 (B) and 1.27 (C) per person per year (Table). Patients with prior exacerbations had an increased likelihood of moderate or severe exacerbation during follow-up (B+C: 71%; B: 70%; C: 87%) versus patients in Group A. Data remained consistent over 3 years. Conclusions: In patients with COPD, increased likelihood and rate of subsequent exacerbation was observed after one prior exacerbation. Targeting patients with an exacerbation history may reduce related healthcare costs and support decision-makers with demand planning.