Impact of the coronavirus disease 2019 pandemic on lung function testing in the chronic obstructive pulmonary disease and asthma population: a population-based study

SESSION TITLE: Obstructive Lung Disease Posters 7 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Spirometry is an essential test recommended to diagnose and monitor respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The use of spirometry in patients with or at risk of developing respiratory symptoms could lead to early detection of disease and early management could prevent further deterioration of lung function and quality of life. The coronavirus disease 2019 (COVID-19) pandemic disrupted the availability and accessibility of spirometry and prompted guidance to limit use of testing during the pandemic period. This study identifies the change in utilization of lung function testing in patients with COPD and asthma from 2018 to 2022. METHODS: This retrospective longitudinal cohort study used the Optum Research Database to identify patients aged ≥18 years with ≥2 separate asthma diagnoses and patients aged ≥40 years with ≥2 separate COPD diagnoses who were treated with maintenance therapy and continuously enrolled for a 12-month baseline period. Patients with asthma were stratified by severity and patients with COPD were stratified by maintenance therapy class at index. Percentage of patients with ≥1 spirometry test were reported annually in the baseline period and monthly in the follow-up period, beginning January 2018. Spirometry test results were not available. RESULTS: A total of 139,128 patients with COPD and 143,053 patients with asthma were identified. Mean (standard deviation [SD]) age was 71.8 (9.8) years for patients with COPD and 59.8 (17.2) years for patients with asthma. Both cohorts included more female patients (58.2% COPD; 69.4% asthma). As of January 2018, 37% (n=51,699) of patients with COPD and 41% (n=58,489) of patients with asthma had received spirometry testing. From January 2018 to February 2020, the monthly proportion of patients with spirometry varied from 2.7–3.9% in patients with COPD and 3.2–4.3% in patients with asthma. Following COVID-19 restrictions in March 2020, monthly spirometry utilization decreased to approximately 0.5% in both cohorts in April 2020. Spirometry utilization then appeared to increase gradually in both cohorts until May 2022 (~2.5%) but has not yet returned to pre-pandemic levels. In patients with COPD, monthly spirometry utilization appeared to be higher among patients on LAMA-LABA or ICS-LAMA-LABA at index. In the asthma cohort, monthly spirometry utilization appeared to be higher in patients with severe asthma compared with non-severe asthma. CONCLUSIONS: Lung function testing utilization has been negatively impacted by COVID-19 and has not returned to pre-pandemic frequencies in real-world practice. CLINICAL IMPLICATIONS: Post-pandemic healthcare practice should continue to encourage earlier and more frequent spirometry testing when guidelines deem it appropriate, to improve early diagnosis and long-term outcomes for patients with COPD and asthma. DISCLOSURES: Employee relationship with Optum Please note: AUG2009 to current Added 03/31/2023 by Tim Bancroft, source=Web Response, value=Salary Stock/stock options relationship with GSK Please note: 06/04/2023 Added 04/06/2023 by Helen Birch, source=Web Response, value=stock options Employee relationship with GSK Please note: 06/04/2023 Added 04/06/2023 by Helen Birch, source=Web Response, value=Salary Employee relationship with GSK Please note: >$100000 by Christopher Compton, value=I hold shares in GSK>$100000 by Christopher Compton, value=Salary No relevant relationships by Steve Gelwicks No disclosure on file for Afisi Ismaila Post-Doctoral Fellow sponsored by GSK relationship with GSK Please note: 07/01/22-06/01/24 Added 03/27/2023 by Lydia (Yejin) Lee, source=Web Response, value=Fellowship sponsorship Employee relationship with GSK Please note: 2022-current Added 04/03/2023 by Stephen Noorduyn, source=Web Response, value=Salary Employee relationship with AstraZeneca Please note: 2018-2022 Added 04/03/2023 by Stephen Noorduyn, value=Salary Stock owner relationship with Eli Lilly and Company Please note: 2008 - 09/15/2022 Added 04/07/2023 by Rosirene Paczkowski, source=Web Response, value=Stock Employee relationship with Eli Lilly and Company Please note: 2008 - 09/15/2022 Added 04/07/2023 by Rosirene Paczkowski, source=Web Response, value=Salary Stock owner relationship with GSK Please note: 09/16/2022- present Added 04/07/2023 by Rosirene Paczkowski, source=Web Response, value=Stock Employee relationship with GSK Please note: 09/16/2022 - present Added 04/07/2023 by Rosirene Paczkowski, source=Web Response, value=Salary No relevant relationships by Gema Requena Employee relationship with GlaxoSmithKline Please note: July 2019 to present by Kieran Rothnie, value=Salary No relevant relationships by Andrea Steffens