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A groundbreaking observational study utilizing the APEX COPD Registry has unveiled significant new insight into the prevalence of Preserved Ratio Impaired Spirometry (PRISm) among US primary care patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) . The findings reveal that approximately one in four patients with clinically diagnosed COPD meet the spirometric criteria for PRISm, highlighting a population that often experiences substantial respiratory symptoms despite not fitting the conventional COPD obstruction criteria. Conducted as part of the APEX COPD registry, this study analyzed data from patients aged 35 and older who have been diagnosed with COPD. The study aimed to characterize the US primary care PRISm patient population, particularly focusing on its prevalence and associated clinical features, including CT scan characteristics and the burden of respiratory symptoms. Despite not meeting the traditional spirometric definitions for COPD, patients categorized with PRISm were found to exhibit significant rates of emphysema on CT imaging and a high burden of respiratory symptoms that may indicate a need for tailored respiratory management strategies. Our findings underscore the importance of recognizing PRISm as a significant subgroup within the COPD population in primary care, potentially as an identifier for early COPD intervention. These patients experience considerable respiratory distress and may benefit from earlier, more targeted clinical interventions, to slow down disease progression prior to measurable lung function decline and alleviate the high symptom burden they experience. Clinical professionals can use a broader and more diverse approach to diagnosing COPD when spirometry results are unclear. Additional tests are necessary to support clinician decision-making and are essential for elucidating the diagnosis and treatment of COPD in situations where spirometry alone may not yield a definitive diagnosis. The implications of this research are critical, as it raises awareness about the need for more comprehensive assessment and management strategies for patients with COPD in primary care settings. To learn more about the study, please read the  full publication  in the   Pragmatic and Observational Research .  About APEX COPD Registry The APEX COPD  registry is a pivotal resource aimed at improving the understanding of Chronic Obstructive Pulmonary Disease through comprehensive data collection. It serves as a platform for research and collaboration, enabling healthcare professionals to enhance the quality of care for patients with COPD. APEX COPD was established and maintained by Optimum Patient Care (OPC) Global Limited , and research was conducted by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) .

As members of the Observational and Pragmatic Research Institute Team in Singapore, we actively seek out opportunities that resonate with our commitment to sustainability and corporate social responsibility. When we discovered City Sprouts, a beacon of urban sustainability, we eagerly volunteered to immerse ourselves in their eco-conscious initiatives. Our day began with an engaging farm tour led by the passionate team at City Sprouts. We marveled at their innovative farming practices, from organic cultivation to water-saving techniques, all designed to minimize environmental impact. Inspired by what we had learned, we rolled up our sleeves and delved into our first task: weed removal. With each weed carefully uprooted, we understood the importance of preserving native flora and fauna for a thriving urban environment. Next, we turned our attention to pruning tree branches, ensuring the safety and aesthetics of the green spaces. But perhaps the most fulfilling part of our day was composting the weeds we had removed. Transforming waste into valuable fertilizer demonstrated the circular economy in action. Throughout our volunteering experience, we were struck by City Sprouts' holistic approach to sustainability. Their emphasis on education, community engagement, and environmental stewardship resonated deeply with our own values as a research organisation. In addition to our focus on sustainability, we also prioritize employee well-being and team bonding. Our day with City Sprouts provided an opportunity to strengthen our bonds as a team, fostering camaraderie amidst the tasks at hand. As we bid farewell to City Sprouts, we left with a renewed sense of purpose and a commitment to continue supporting initiatives that prioritize sustainability, employee well-being, and team bonding. Our day of volunteering was a testament to the power of collective action to create a more sustainable and fulfilling future for all.

The International Severe Asthma Registry (ISAR) ’s newest study has determined comorbidities and multimorbidity to be frequent in adults with severe asthma in real-life, and that their presence is associated with poorer asthma-related outcomes. The study, which used data from 11, 821 patients across 22 countries from ISAR, identified over half the patients to have at least 3 comorbidities. Two thirds of patients had at least 1 potentially type 2-related comorbidity and potentially oral corticosteroid (OCS)-related comorbidity. More than half the patients had at least 1 comorbidity that mimics /aggravates asthma comorbidities. Patients who had nasal polyposis and chronic rhinosinusitis experienced more exacerbations in a year than those who did not, and were more likely to receive long-term OCS. Meanwhile, comorbidities mimicking/aggravating asthma were associated with more exacerbations, increased likelihood of uncontrolled asthma, and increased likelihood of long-term OCS. "Our findings emphasize the intricate relationship between severe asthma and comorbidities. A systematic evaluation for comorbidities needs to be in place during routine asthma review as it is clear doing so could improve patient outcomes. It can also foster a multi-disciplinary approach to asthma management that’s effective and holistic." says Professor David Price, who leads the ISAR. To learn more about the study, please read the full publication, titled “Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry” in Annals of Allergy, Asthma & Immunology . .

ISAR ’s new publication ‘ Adult severe asthma registries: a global and growing inventory ’ to the journal Pragmatic and Observational Research celebrates the collaboration of the global asthma community to collect standardised data; encompassing data utilisation across 35 countries by 37 registries. Core variables resulting from ISAR’s Delphi study were found to be collected to >90% in the majority of severe asthma registries. This standardisation of data collection across registries enables data interoperability across the world, enhances statistical power of research conducted and, critically, catalyses the assembly of a global community with the common goal of enhancing care in severe and high risk asthma through high quality research. Going beyond research, standard data collection has set up previously disparate severe asthma ecosystems to adopt a global standard of care through quality improvement programs. The paper also highlights the utility of collecting individual country variables alongside standardized variables to support targeting for specific additional research questions such as linkage to EMR data. To learn more about the study, please read the full publication in Pragmatic and Observational Research , as well as the accompanying slide deck.

Singapore, [21 February 2024] – A ground-breaking study conducted by an international consortium of leading respiratory experts sheds new light on the management of chronic obstructive pulmonary disease (COPD). The study, titled "Risk of Pneumonia in Patients with COPD Initiating Fixed Dose ICS/LABD Containing Extrafine Beclometasone Dipropionate," challenges conventional wisdom by demonstrating no increased risk of pneumonia associated with the use of extrafine beclometasone dipropionate (ef-BDP) in inhaler therapy among COPD patients. It has just been published in this month’s issue of the medical journal Pragmatic & Observational Research. This research was conducted across a diverse UK real-world clinical population by comparing the pneumonia risk among new users of fixed-dose inhaled corticosteroid (ICS)/long-acting bronchodilator (LABD) formulations containing ef-BDP versus patients initiating LABD therapy without any ICS. It involved an international team of academic investigators from nine countries (Singapore, the UK, Brazil, Italy, The Netherlands, France, Turkey, Germany, and Spain). Professor David B. Price, the lead author and Head of the Observational and Pragmatic Research Institute, emphasized, "Our findings challenge the prevailing understanding of ICS use in COPD management. The risk of pneumonia associated with ICS reported in previous studies may not be relevant when using extrafine beclometasone dipropionate." The study utilized a propensity-matched historical cohort design and drew data from 23,898 COPD patients. Results indicated that initiation of ef-BDP/LABD therapy did not elevate the risk of pneumonia when compared to LABD therapy alone. The probability of remaining pneumonia-free after initiating ef-BDP/LABD was  98.4% at one year, comparable to the 97.7% observed in LABD therapy alone. Importantly, this was sustained over six years of observation, meeting non-inferiority criteria for both sensitive and specific definitions of pneumonia. Moreover, the study found an additional benefit associated with ef-BDP/LABD therapy, showing a reduced risk of lower respiratory tract infections (LRTIs) in the propensity-matched cohort, further highlighting the potential advantages of this treatment approach. Professor Price remarked, "This research provides new findings, suggesting that the risk of pneumonia, a concern associated with ICS use, may not be a significant factor when employing ef-BDP in real-world clinical settings." This international study is poised to inform clinical practice and shape future guidelines for the management of COPD. This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was funded by Chiesi Farmaceutici S.p.A. Read the full article here .

Singapore, [4 December 2023] - Results from a real-world research study have highlighted the risks associated with the long-term use of oral corticosteroids (OCS) in patients with chronic obstructive pulmonary disease (COPD). Intermittent OCS are prescribed to around one in three COPD patients in the UK as well as in most developed countries. Systemic corticosteroids are known to be related with many adverse outcomes. The study entitled "A Long-Term Study of Adverse Outcomes Associated With Oral Corticosteroid Use in COPD," is published in this month’s issue of the International Journal of Chronic Obstructive Pulmonary Disease. The study was conducted by the Observational & Pragmatic Research Institute and sponsored by AstraZeneca .   Dr. Gary Tse, from the School of Nursing and Health Studies of the Hong Kong Metropolitan University , led the research which also involved a team of distinguished researchers from across the globe including Dr. Benjamin Emmanuel, Prof. Mona Bafadhel, Prof. Alberto Papi and Professor David Price. The study examined electronic medical records spanning 32 years (1987–2019) from the UK Clinical Practice Research Datalink, coupled with English Hospital Episode Statistics (HES). A wide range of adverse outcomes were evaluated which are known to be potentially related to treatment with corticosteroids among COPD patients compared to those not exposed to such treatments.   Key findings which included data from 323,722 patients, revealed that 33.0% had at least one COPD-related OCS prescription. Of the eligible 58,955 patients included in the OCS cohort, the matched analysis highlighted significantly higher risks of corticosteroid related adverse outcomes compared to the non-OCS cohort. All-cause mortality was also notably elevated in the OCS cohort. These effects were worse in those with a higher dose of OCS exposure. For example, cumulative doses over 1gm of 4 lifetime courses were associated with increased risk of cardiovascular disease.    Dr. Tse reports that, “After seven years, COPD patients that were prescribed OCS (vs. those not prescribed OCS), had significantly greater risks of osteoporosis, type-2 diabetes mellitus, or cardiovascular/cerebrovascular disease, plus a 4% greater risk of death, all with a dose-response.”    Professor David Price, a lead researcher and corresponding author, stated, "Our study identifies a critical association between oral corticosteroid use and increased risks of adverse outcomes and mortality in COPD patients. These findings underscore the importance of careful consideration and monitoring of OCS usage, particularly concerning cumulative doses, in the management of COPD."    This research sheds light on the implications of OCS use in COPD patients and emphasizes the need for vigilant monitoring of treatment strategies in COPD.  For media inquiries and additional information, please contact https://www.opri.org.uk/contact Read the full article here: https://doi.org/10.2147/COPD.S433326

Today, the Observational & Pragmatic Research Institute (OPRI) and affiliate organization Optimum Patient Care (OPC) announced the results of the latest observational study for the Co llaboratio n on Qu ality Improvement Initiative for Achieving E xcellence in St andards of Chronic Obstructive Pulmonology Disease (COPD) care ( CONQUEST program ), that is being delivered in collaboration with respiratory experts and AstraZeneca . Focused on the management of patients with high-risk* COPD in the United States (US), the CONQUEST program’s opportunity analysis highlighted areas to enhance patient care, spanning from the point of diagnosis through to maximizing therapy and patient assessment. Accessing US electronic medical records, provided by the DARTNet Institute, for ~1 million patients, OPRI evaluated 9-years of COPD management practices against national, international and CONQUEST Quality Standards , from 2011 through 2019. Top 3 Areas of Opportunity in US Primary Care 1. Earlier opportunities to enhance identification of those at high-risk of respiratory flare-ups and other exacerbation events In 2019, 12.8% of patients newly diagnosed with COPD were high-risk, and almost 1 in 3 of these patients had 3 or more exacerbations (acute chest infections or similar events) in the 12-months before diagnosis. Among these newly diagnosed patients, there was scope to conduct systematic COPD review (including symptom assessment) in 42.7% of patients, 12 months either side of their diagnosis. 2. Opportunities to increase diagnostic & risk assessments in patients with high-risk COPD Nearly all (98%) patients with high-risk COPD had no evidence of cardiovascular (CV) risk assessment, which is particularly important given the growing body of evidence surrounding the associations between COPD exacerbation events and CV events. Moreover, large opportunities to conduct diagnostic assessments persist in patients with high-risk COPD. Approximately 80% were without record of diagnostic assessment by lung function testing, despite it being a critical component of diagnostic criteria. 3. Opportunities to optimize pharmacological intervention for patients with high-risk COPD Treatment could be optimized for over 50% of patients with high-risk COPD who, in 2019, were on no inhaled therapy, with an additional 12% of patients receiving relievers only and ~9% on monotherapies. Per current Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations, many, if not all, of these high-risk patients would benefit from initiating or stepping up their treatment. ‘‘ Collectively, our findings underscore the long-term opportunities for enhancements in COPD management in US primary care ’’, shared Professor David Price, ‘‘ but they also call for improvements in the consistency of coding of data in electronic medical records ’’. OPRI’s founder later added that ‘‘ CONQUEST will tackle these areas by working with physicians to not only ensure they have access to accurate information but to also provide clinical decision support at the point of care .’’ Recognizing this scope for improved high-risk COPD management presents opportunities to affect patient outcomes in US primary care. While this study did not include data from the pandemic, the scope for change has likely expanded further since then, given the significant and persistent impacts of COVID-19 on how care is being delivered. Dr Barry Make, Steering Committee member, and Pulmonologist at National Jewish Health , also shared that ‘‘given the extent of both under- and misdiagnosis of COPD in the United States, these results highlight the significance of a program like CONQUEST that drive the implementation of earlier, comprehensive disease assessment, that includes monitoring risk of future adverse respiratory and cardiovascular events.’’   To view the full results of CONQUEST’s US Opportunity Analysis study and the scope for change, read the paper here . *Patients at high-risk were identified as those who had experienced ≥2 moderate or ≥1 severe (requiring hospitalization) exacerbations, or probable exacerbations (for patients with suspected but undiagnosed COPD) in the previous 24 months, with one of these events occurring in the last 12 months. COPD exacerbations are a large healthcare burden in COPD, and carry considerable consequences, including lung function decline, cardiac events, and steroid-related side effects. About CONQUEST CONQUEST is a collaborative, interventional COPD registry that drives long-term, targeted, patient-centred changes in COPD management. The promotion of expert and guideline-led care aims to reduce exacerbation frequency and improve health care outcomes. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. CONQUEST is underpinned by four evidence-based Quality Standards developed by 11 experts internationally recognized in their field. CONQUEST is co-funded by AstraZeneca and OPC. About COPD Approximately 16 million people have COPD in the US alone. COPD is a group of progressive lung diseases, of which the most common are emphysema and chronic bronchitis. Common COPD symptoms include frequent coughing or wheezing, excess mucus production, shortness of breath and trouble taking a deep breath. While there is no cure for COPD, treatment can help ease symptoms, lower the chance of complications, and generally improve health related quality of life.

The International Severe Asthma Registry (ISAR) ’s newest study has found that keeping severe asthma patients on high oral corticosteroid exposure (HOCS*) or initiating biologics can both result in improvements in severe asthma. However, HOCS patients who received biologics experienced greater improvements. Patients who received biologics had a 72.9% reduction in exacerbation rates, and nearly one-third the risk and frequency of asthma-related emergency department visits and hospitalisations when matched and compared to patients who did not receive biologics. The study, which used data from 996 pairs of patients across 19 countries from ISAR, also found that patients who received biologics were over twice as likely to achieve a daily OCS dose of <5mg than patients who did not. “These findings support evolving guidelines recommending biologics in patients showing improvement on long-term OCS. They prove that biologics can be a cost-effective strategy to improve outcomes in asthma patients while reducing high oral corticosteroid exposure,” Remarked Professor David Price, who leads the ISAR. To learn more about the study, please read the full publication , titled “Impact of initiatin G bio L ogics I n patients with severe as T hma on long- T erm OCS or fr E quent R escue steroids (GLITTER): data from the International Severe Asthma Registry” in The Journal of Allergy and Clinical Immunology: In Practice. *HOCS was defined as long-term OCS ≥1 year or ≥4 courses of rescue OCS within a 12-month period

Optimum Patient Care (OPC) and the Observational and Pragmatic Research Institute (OPRI) today announced the results of the latest UK observational study for the Co llaboratio n on Qu ality Improvement Initiative for Achieving E xcellence in St andards of Chronic Obstructive Pulmonary Disease (COPD) care (CONQUEST), which is being conducted in collaboration with AstraZeneca . Focused on UK primary care, the study demonstrated key areas to enhance care for exacerbating COPD patients to minimise the risk of future cardiopulmonary events, including earlier diagnosis and increased patient monitoring and risk assessment. To highlight such opportunities, the analysis assessed data from the Optimum Patient Care Research Database , containing >30-years of data, and records from >17 million patients. Using this unique resource, OPRI explored the clinical management of high-risk* COPD patients between 2000-2019, compared to national, global and CONQUEST Quality Standards . 4 Top Areas of Opportunity 1. Earlier Identification of COPD in Patients Experiencing Respiratory Flare-ups Pre-Diagnosis 35% of patients experienced ≥2 moderate or ≥1 severe exacerbations many years prior to receiving a diagnosis of COPD. The scope for earlier identification (up to 10-years before diagnosis) remains unchanged from that reported by the OPRI group almost a decade ago. 2. Conducting Cardiac Risk Assessment in COPD Patients Experiencing Exacerbations** who are at High-Risk of Myocardial Infarction and other Cardiac Events Scope to conduct cardiac risk assessment in >80% of both newly and already diagnosed high-risk patients. 3. Optimisation of Treatment in Patients with High-risk COPD Opportunity to optimise medication management for the 45% of newly diagnosed patients who had no record of a COPD medication review within 6 months of treatment initiation or change. 4. Pulmonary Rehabilitation Referral for Symptomatic Diagnosed Patients Scope to offer or refer 66% of newly diagnosed patients to pulmonary rehabilitation. Pulmonary rehabilitation is one of the most effective interventions in COPD to improve symptoms and health related quality of life. ‘‘ Our findings highlight clear opportunities for earlier intervention in UK primary care for patients with high-risk COPD’’ , explained Professor David Price. ‘‘ CONQUEST addresses these areas, and goes one step further, by automating processes for physicians, to ensure early diagnosis, cardiopulmonary risk assessment and adequate treatment become the standard of care’’ , added OPRI’s founder and CEO. Identifying and acknowledging this scope for improving COPD management presents major opportunities to influence patient outcomes in UK primary care. Given the pressures imposed on primary care by the COVID-19 pandemic, it is likely there is now even greater potential for change in assessment and treatment of these high-risk patients. Vice President of Medical, Respiratory & Immunology for AstraZeneca, Robert Fogel, remarked “ At AstraZeneca, we are committed to addressing the vast patient and systemic burden of COPD with a goal of cutting the exacerbation rate in half by 2030 and reducing the associated cardiopulmonary mortality risk. To achieve this, we need strong partnerships with the scientific community, like the one we have through CONQUEST, to help establish and implement quality standards to improve outcomes for patients at high risk due to COPD. ” To view the full results of CONQUEST’s UK Opportunity Analysis study and the scope for change, read the paper in The Lancet Regional Health - Europe . *High-risk: patients with ≥2 moderate or ≥1 severe (requiring hospitalization) exacerbations in the previous 12 months. ** COPD exacerbations are a major healthcare burden in COPD, and carry considerable consequences, including lung function decline, cardiac events, and steroid-related side effects. About CONQUEST CONQUEST is a collaborative, interventional COPD registry that drives long-term, targeted, patient-centred changes in COPD management. The promotion of expert and guideline-led care aims to reduce exacerbation frequency and improve health care outcomes. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. CONQUEST is underpinned by four evidence-based Quality Standards developed by 11 experts internationally recognized in their field. CONQUEST is co-funded by AstraZeneca and OPC.