title: COPD management in primary care: an observational, community pharmacy-based study.
abstract: 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.
authors.affiliation: Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium. els.mehuys@ugent.be
authors.forename: Els
authors.initials: E
authors.lastname: Mehuys
authors.forename: Koen
authors.initials: K
authors.lastname: Boussery
authors.forename: Els
authors.initials: E
authors.lastname: Adriaens
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.forename: Leen
authors.initials: L
authors.lastname: De Bolle
authors.forename: Inge
authors.initials: I
authors.lastname: Van Tongelen
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Remon
authors.forename: Guy
authors.initials: G
authors.lastname: Brusselle
mesh_terms: 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
chemical_list: D000336:Aerosols; D007252:Influenza Vaccines; D004364:Pharmaceutical Preparations