Are COPD Prescription Patterns Aligned with Guidelines? Evidence from a Canadian Population-Based Study

In contemporary guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD), the history of acute exacerbations plays an important role in the choice of long-term inhaled therapies. This study aimed at evaluating population-level trends of filled inhaled prescriptions over the time...

Full description

Saved in:

Bibliographic Details
Published in:	International journal of chronic obstructive pulmonary disease 2021-01, Vol.16, p.751-759
Main Authors:	Bahremand, Taraneh, Etminan, Mahyar, Roshan-Moniri, Nardin, De Vera, Mary A, Tavakoli, Hamid, Sadatsafavi, Mohsen
Format:	Article
Language:	eng
Subjects:	Administration, Inhalation Adrenal Cortex Hormones - therapeutic use Adrenergic beta-2 Receptor Agonists - therapeutic use Aged Analysis British Columbia - epidemiology Bronchodilator Agents - therapeutic use Chronic illnesses Chronic obstructive pulmonary disease copd Disease management Drug dosages Drug Prescriptions Drug therapy Drug Therapy, Combination exacerbation Family physicians Female Generalized linear models Hospitalization Humans Inhalers Lung diseases, Obstructive Male medication Muscarinic Antagonists - therapeutic use Online databases Original Research Outpatient care facilities Patients Population Population-based studies prescription Prescriptions Pulmonary Disease, Chronic Obstructive - diagnosis Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - epidemiology Respiratory agents Retrospective Studies time trend Trends
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	In contemporary guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD), the history of acute exacerbations plays an important role in the choice of long-term inhaled therapies. This study aimed at evaluating population-level trends of filled inhaled prescriptions over the time course of COPD and their relation to the history of exacerbations. We used administrative health databases in British Columbia, Canada (1997-2015), to create a retrospective incident cohort of individuals with diagnosed COPD. We quantified long-acting inhaled medication prescriptions within each year of follow-up and documented their trend over the time course of COPD. Using generalized linear models, we investigated the association between the frequent exacerbator status (≥2 moderate or ≥1 severe exacerbation(s) in the previous 12 months) and filling a prescription after a physician visit. 132,004 COPD patients were included (mean age 68.6, 49.2% female). The most common medication class during the first year of diagnosis was inhaled corticosteroids (ICS, used by 49.9%), followed by long-acting beta-2 adrenoreceptor agonists (LABA, 31.8%). Long-acting muscarinic receptor antagonists (LAMA) were the least commonly prescribed (10.4%). ICS remained the most common prescription throughout follow-up, being used by approximately 50% of patients during each year. 39.0% of patients received combination inhaled therapies in their first year of diagnosis, with ICS+LABA being the most common (30.7%). The association with exacerbation history was the most pronounced for triple therapy with an odds ratio (OR) of 2.68 for general practitioners and 2.02 for specialists (p
ISSN:	1178-2005 1176-9106 1178-2005