COPD management in primary care: an observational, community pharmacy-based study.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management.


OBJECTIVE
To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies.


METHODS
A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale.


RESULTS
The mean age of the patients was 68.6 years; 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7%) than in patients aged 65 years or more (86.2%) (p < 0.001). Fixed combinations of inhaled corticosteroids and long-acting beta(2)-agonists were the most frequently used COPD medications (75.4%). About 48% of patients were underadherent (<80% adherence), 47% were adherent (80-120% adherence) and 5% were overadherent (>120% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs).


CONCLUSIONS
This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.
Mehuys
Els
E
Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium. els.mehuys@ugent.be
Boussery
Koen
K
Adriaens
Els
E
Van Bortel
Luc
L
De Bolle
Leen
L
Van Tongelen
Inge
I
Remon
Jean-Paul
JP
Brusselle
Guy
G
D000280:Administration, Inhalation; D000336:Aerosols; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D055118:Medication Adherence; D008508:Medication Errors; D036501:Metered Dose Inhalers; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
D000336:Aerosols; D007252:Influenza Vaccines; D004364:Pharmaceutical Preparations