TY - JOUR
T1 - Determinants of initial inhaled corticosteroid use in patients with GOLD A/B COPD
T2 - a retrospective study of UK general practice
AU - Chalmers, James D.
AU - Tebboth, Abigail
AU - Gayle, Alicia
AU - Ternouth, Andrew
AU - Ramscar, Nick
N1 - J.D.C. has received funding from the Wellcome Trust, Medical Research Council, Chief Scientist Office, Scottish Government, Tenovus Scotland, Bayer HealthCare, European Respiratory Society, AstraZeneca, Basilea, GlaxoSmithKline, Boehringer Ingelheim, Napp Pharmaceuticals, Pfizer and Chiesi. Ab.T., A.G., and An.T. are employees of Boehringer Ingelheim, the study sponsor.
PY - 2017/6/29
Y1 - 2017/6/29
N2 - Initial use of inhaled corticosteroid therapy is common in patients with Global Initiative for Chronic Obstructive Lung Disease
(GOLD) A or B chronic obstructive pulmonary disease, contrary to GOLD guidelines. We investigated UK prescribing of inhaled
corticosteroid therapy in these patients, to identify predictors of inhaled corticosteroid use in newly diagnosed chronic obstructive
pulmonary disease patients. A cohort of newly diagnosed GOLD A/B chronic obstructive pulmonary disease patients was identified
from the UK Clinical Practice Research Datalink (June 2005–June 2015). Patients were classified by prescribed treatment, with those
receiving inhaled corticosteroid-containing therapy compared with those receiving long-acting bronchodilators without inhaled
corticosteroid. In all, 29,815 patients with spirometry-confirmed chronic obstructive pulmonary disease were identified. Of those
prescribed maintenance therapy within 3 months of diagnosis, 63% were prescribed inhaled corticosteroid-containing therapy vs.
37% prescribed non-inhaled corticosteroid therapy. FEV1% predicted, concurrent asthma diagnosis, region, and moderate
exacerbation were the strongest predictors of inhaled corticosteroid use in the overall cohort. When concurrent asthma patients
were excluded, all other co-variates remained significant predictors. Other significant predictors included general practitioner
practice, younger age, and co-prescription with short-acting bronchodilators. Trends over time showed that initial inhaled
corticosteroid prescriptions reduced throughout the study, but still accounted for 47% of initial prescriptions in 2015. These results
suggest that inhaled corticosteroid prescribing in GOLD A/B patients is common, with significant regional variation that is
independent of FEV1% predicted.
AB - Initial use of inhaled corticosteroid therapy is common in patients with Global Initiative for Chronic Obstructive Lung Disease
(GOLD) A or B chronic obstructive pulmonary disease, contrary to GOLD guidelines. We investigated UK prescribing of inhaled
corticosteroid therapy in these patients, to identify predictors of inhaled corticosteroid use in newly diagnosed chronic obstructive
pulmonary disease patients. A cohort of newly diagnosed GOLD A/B chronic obstructive pulmonary disease patients was identified
from the UK Clinical Practice Research Datalink (June 2005–June 2015). Patients were classified by prescribed treatment, with those
receiving inhaled corticosteroid-containing therapy compared with those receiving long-acting bronchodilators without inhaled
corticosteroid. In all, 29,815 patients with spirometry-confirmed chronic obstructive pulmonary disease were identified. Of those
prescribed maintenance therapy within 3 months of diagnosis, 63% were prescribed inhaled corticosteroid-containing therapy vs.
37% prescribed non-inhaled corticosteroid therapy. FEV1% predicted, concurrent asthma diagnosis, region, and moderate
exacerbation were the strongest predictors of inhaled corticosteroid use in the overall cohort. When concurrent asthma patients
were excluded, all other co-variates remained significant predictors. Other significant predictors included general practitioner
practice, younger age, and co-prescription with short-acting bronchodilators. Trends over time showed that initial inhaled
corticosteroid prescriptions reduced throughout the study, but still accounted for 47% of initial prescriptions in 2015. These results
suggest that inhaled corticosteroid prescribing in GOLD A/B patients is common, with significant regional variation that is
independent of FEV1% predicted.
KW - Chronic obstructive pulmonary disease
KW - Therapeutics
U2 - 10.1038/s41533-017-0040-z
DO - 10.1038/s41533-017-0040-z
M3 - Article
C2 - 28663549
SN - 2055-1010
VL - 27
SP - 1
EP - 8
JO - NPJ Primary Care Respiratory Medicine
JF - NPJ Primary Care Respiratory Medicine
M1 - 43
ER -