Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)

Román-Rodríguez, Miguel; Boven, Job F M van; Vargas, Freya; Contreras, Cecilia C; Lamelas, Gema; Gestoso, Salvador; Góngora, Miguel; Corredor, Maite; Esteva, Magdalena

doi:10.1080/13814788.2016.1212011

Cited by 5 publications

(6 citation statements)

References 28 publications

(33 reference statements)

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“…As expected, severe and very severe airflow limitation, comorbidity of asthma, frequent exacerbations, and contact with secondary care were associated with ICS-containing therapy, and this is also supported by other studies 5,30. Among the patients who would benefit from ICS treatment (Table 1), the patients with “possible indication for ICS” had a better lung function when compared with the patients with “appropriate therapy with ICS”, which might be a reason why they did not have ICS treatment despite reported comorbidity of asthma.…”

Section: Discussionsupporting

confidence: 86%

A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden

Sulku¹,

Janson²,

Melhus³

et al. 2019

COPD

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PurposeInhaled corticosteroids (ICS) are often more widely prescribed in the treatment of chronic obstructive pulmonary disease (COPD) than what is recommended in the guidelines. The aim of this study was to evaluate the appropriateness of ICS treatment in COPD patients using the algorithm proposed by the International Primary Care Respiratory Group (IPCRG) and to identify factors associated with ICS treatment.Patients and methodsAppropriateness of ICS therapy was studied with respect to concomitant asthma, history of exacerbations and blood eosinophils (B-Eos) in a Swedish cohort of primary and secondary care patients with COPD. Factors associated with ICS were investigated using multivariable logistic regression.ResultsTriple treatment was found to be the most common treatment combination, used by 46% of the 561 included patients, and in total 63% were using ICS. When applying the IPCRG algorithm, there was a possible indication for discontinuation of ICS in 55% of the patients with ICS treatment. Of the patients not using ICS, 18% had an indication for starting such treatment. The strongest factors associated with ICS therapy were frequent exacerbations (aOR 8.61, 95% CI 4.06, 20.67), secondary care contacts (aOR 6.99, 95% CI 2.48, 25.28) and very severe airflow limitation (aOR 5.91, 95% CI 1.53, 26.58).ConclusionMore than half of the COPD patients on ICS met the criteria where withdrawal of the treatment could be tried. There was, however, also a subgroup of patients not using ICS for whom there was an indication for starting ICS treatment. Patients using ICS were characterized by more frequent exacerbations and lower lung function.

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Section: Discussionsupporting

confidence: 86%

A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden

Sulku¹,

Janson²,

Melhus³

et al. 2019

COPD

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“…Over two-thirds of COPD patients between 2014 and 2018 were prescribed ICS-containing inhaled therapy, in particular triple therapy; similar to the proportion seen in Sweden but higher than that found in the Balearic Islands (Spain). 24,25 In keeping with guideline changes and recommendations during this time period, the proportion prescribed non-ICS inhaled therapy steadily…”

Section: Discussionmentioning

confidence: 88%

Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study

Bloom¹,

Douglas²,

Usmani³

et al. 2020

COPD

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Background: Inhaled corticosteroids (ICS) are a prevailing treatment option for COPD patients but recent guidelines have relegated their use predominantly to patients with frequent exacerbations. Yet large numbers of patients worldwide are currently treated with ICS-containing regimens. We wished to determine in routine clinical practice how common ICS withdrawal is and the differences in health outcomes between patients managed on ICScontaining and non-ICS containing regimens. Patients and Methods: COPD patients were identified from the UK primary care electronic healthcare records, between 2014 and 2018. Patients were grouped into three treatment regimens: long-acting beta-agonist (LABA) and inhaled corticosteroids (ICS), LABA and long-acting muscarinic antagonist (LAMA), and triple therapy (LABA, LAMA and ICS). Annual incidence of ICS withdrawal was measured. Multivariable logistic regression was used to identify patient factors associated with withdrawal. Multivariable Poisson regression was used to assess the association of exacerbations and hospitalised pneumonia between the ICS-containing regimens (LABA-ICS and triple therapy) and patients prescribed LABA-LAMA. Results: Of 117,046 patients, around three-quarters were prescribed ICS-containing inhalers but ICS withdrawal occurred annually in only approximately 2-3% of patients. Exacerbations in the past year, but not a past history of pneumonia, were associated with ICS withdrawal. A total of 31,034 patients using three treatment regimens (LABA-ICS, LABA-LAMA or triple therapy) were assessed for their relative risk of exacerbations and pneumonia; the exacerbation risk was slightly lower in LABA-ICS users but the same in triple therapy users, as compared to LABA-LAMA users (LABA-ICS adjusted IRR=0.82 (95% CI 0.73-0.93), triple adjusted IRR=0.99 (95% CI 0.88-1.11)). There was no difference in the pneumonia risk (LABA-ICS adjusted IRR=0.96 (95% CI 0.71-1.31), triple adjusted IRR=1.16 (95% CI 0.87-1.57)). Conclusion: Use of ICS-containing inhaled medication is prevalent across the UK while ICS withdrawal from established treatment was relatively uncommon. Exacerbations and pneumonia risk was similar between the ICS-containing and non-ICS containing treatment regimens.

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“…Despite the valuable information these studies provide, they are frequently based on automated databases that do not allow to understand the determinants of pharmacological prescription in daily clinical practice. Although some previous studies have assessed this aspect, 6 , 7 , 9 , 10 most of these studies are conducted in primary care and evaluate only partial aspects of drug prescription. Accordingly, there is a need for a prospective, comprehensive evaluation on what are the key elements on which physicians base their therapeutic decisions in secondary care.…”

Section: Introductionmentioning

confidence: 99%

Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit

Lόpez-Campos

Alcázar²,

Soriano

et al. 2018

COPD

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PurposeCurrent COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy.MethodsEPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014–May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models.ResultsPatterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other nonspecified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype.ConclusionThe EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs.

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Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)

Cited by 5 publications

References 28 publications

<p>A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden</p>

<p>A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden</p>

<p>Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study</p>

Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit

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