Treatment patterns in COPD patients newly diagnosed in primary care. A population-based study

Barrecheguren, Miriam; Monteagudo, Mónica; Ferrer, Jaume; Borrell, Eulàlia; Llor, Carles; Esquinas, Cristina; Miravitlles, Marc

doi:10.1016/j.rmed.2015.12.004

Cited by 80 publications

(78 citation statements)

References 47 publications

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“…[19] A recent similar analysis of Catalonian primary care real-life data shows that only 45.2% of patients were initially treated with ICS, which were frequently prescribed in asthma-COPD overlap syndrome (ACOS) (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non-exacerbator patients. [20] These results from Catalonia are comparable to our results, and they both could be a consequence of current prescription patterns among primary care physicians in Spain according to new Spanish phenotype based COPD guidelines. [1] In our study, asthma comorbidity was one of the factors associated with prescription of ICS, which is in line with the recommendations of the Spanish guidelines (GesEPOC).…”

Section: Comparison With Other Studiessupporting

confidence: 88%

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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)

Román-Rodríguez

Boven

Vargas

et al. 2016

European Journal of General Practice

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KEY MESSAGESThe proportion of COPD patients with ICS prescriptions in Balearic primary care is lower than proportions observed in other studies. Asthma comorbidity, exacerbations, severe bronchial-obstruction, smoking status and spirometry-registered data were associated with ICS prescription. High-dose ICS prescription was associated with severe obstruction, exacerbations and co-morbid asthma. ABSTRACTBackground: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. Objectives: Our aim was to assess the prescription rate of ICS and to identify sociodemographic and clinical factors associated with ICS prescription among patients with COPD, treated in Balearic primary healthcare. Methods: This cross-sectional study included all patients with a clinical COPD diagnosis, who attended a primary care centre of the Balearic Islands (Spain) during 2012. Also, a sub-population with spirometry-confirmed COPD was defined. Data were obtained on patient demographics, smoking status, spirometry, ICS prescriptions, other respiratory medication, exacerbations and comorbidities. Associations with ICS and high-dose ICS prescription were assessed using multivariate regression analyses. Results: In total, 15,440 patients were included (70% men, mean age 68.6 years), and 44.6% were prescribed ICS. The largest association with ICS prescription was asthma comorbidity (OR: 3.50; 95%CI: 3.12-3.92), followed by exacerbation history (OR: 2.23; 95%CI: 2.07-2.47). In addition, smoking status, spirometry, atopic dermatitis, allergic rhinitis and mean age were significantly (P < 0.001) associated with ICS treatment. In the spirometry-confirmed population, asthma (OR: 2.89; 95%CI: 2.29-3.64) and exacerbations were also the major factors (OR: 2.85; 95%CI: 2.45-3.32) followed by severe bronchial-obstruction (OR: 2.63; 95%CI: 2.24-3.08). High-dose ICS prescription was mainly associated with severe obstruction (OR: 2.27; 95%CI: 1.93-2.68). Conclusion: The percentage of COPD patients prescribed ICS in Balearic primary care is relatively low. Asthma comorbidity, exacerbation history, severe bronchial-obstruction, smoking status and a spirometry-confirmed COPD diagnosis were significantly associated with ICS prescription.

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Section: Comparison With Other Studiessupporting

confidence: 88%

“…[1] The prevalence of ACOS in this study (14%) was similar to earlier Spanish studies with prevalence rates of respectively 17% and 11%. [20][21][22] There OR, Odds ratio; FEV1 < 50%, forced expiratory volume in one second smaller than 50% of predicted value.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

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

Román-Rodríguez

Boven

Vargas

et al. 2016

European Journal of General Practice

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“…This low use of spirometry in primary care has been recognized in Spain10,12,13,19 and in other countries 20–22. This indicates that primary care physicians rely on other factors in order to make decisions about treatment.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Monteagudo¹,

Roset²,

Rodríguez-Blanco³

et al. 2017

COPD

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ObjectiveTo describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia.DesignWe performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. A descriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts.ResultsA total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0–8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months.ConclusionPatients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy.

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“…Underdiagnosis of AATD is a global issue. A study from Spain reported that, despite nearly 7,000 new cases of COPD diagnosed in the Catalan region each year from 2007 to 2012, less than 400 AAT tests per year in COPD patients were performed (8,9). In Germany and Italy, only 18-25% of surveyed physicians (pulmonologists, internal medicine specialists and general practitioners) reported performing AATD testing in their COPD populations (7).…”

Section: Aatd Knowledge Relates To Testing Frequencymentioning

confidence: 99%

Alpha-1-Antitrypsin Deficiency: Disease Management and Learning from Studies

Greulich

2017

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Treatment patterns in COPD patients newly diagnosed in primary care. A population-based study

Cited by 80 publications

References 47 publications

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

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

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Alpha-1-Antitrypsin Deficiency: Disease Management and Learning from Studies

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