Résumé
Background: Chronic Obstructive Pulmonary Disease (COPD) is often managed with triple therapy (long-acting ß2-agonist, long-acting anticholinergic, and inhaled corticosteroids). Despite this, some patients experience exacerbations and persistent symptoms, indicating poor disease control. This study aimed to describe the characteristics of uncontrolled COPD patients and assess the clinical burden by comparing overall survival (OS) and exacerbation frequency between uncontrolled COPD patients, controlled COPD patients, and the general population.Methods: This retrospective study included patients over 40 years old, treated with triple therapy for at least 90 consecutive days in 2015, from the French National Health Data System. Patients were followed for up to 5 years. COPD patients were classified as uncontrolled (≥1 severe or 2 moderate exacerbations within 12 months before inclusion) or controlled. A random sample from the general population was included. A propensity score matching (1:2 for uncontrolled vs. general population, 1:1 for uncontrolled vs. controlled) was used. OS was estimated with Kaplan-Meier, and exacerbation risks were assessed using the Kalbfleisch and Prentice method.Results: Of 186,963 COPD patients on triple therapy, 21.2% (n=39,647) were uncontrolled. Uncontrolled patients had a shorter OS and higher mortality risk compared to controlled patients (HR: 1.21; 95% CI: 1.18–1.23) and the general population (HR: 2.51; 95% CI: 2.45–2.57). Median time to first exacerbation was 0.39 years for uncontrolled vs. 1.80 years for controlled patients.Discussion: This study demonstrates the high clinical burden of uncontrolled COPD as defined by persistence of exacerbations, characterized by reduced survival and frequent exacerbations despite triple therapy.