title: Determinants of polypharmacy and compliance with GOLD guidelines in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Polypharmacy of respiratory medications is commonly observed in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD.
  
  
  METHODS
  Data were extracted from the records of all patients with a diagnosis of COPD referred for pulmonary rehabilitation to CIRO+ between 2005 and 2009. Use of respiratory medications, self-reported COPD exacerbations, lung function, blood gases, exercise capacity, Medical Research Council (MRC) dyspnea grade, and St George's Respiratory Questionnaire (SGRQ) were recorded as part of assessment of health status.
  
  
  RESULTS
  In total, 1859 COPD patients of mean age (± standard deviation) 64.3 ± 9.7 years and with a forced expiratory volume in one second (FEV(1)) of 44.7% ± 18.2% were included. On average, patients used 3.5 ± 1.5 respiratory medications; this number increased with increasing GOLD stage, MRC score, and SGRQ scores. FEV(1) (% predicted), SGRQ, and number of recent exacerbations were independent determinants of polypharmacy. Use of long-acting bronchodilators and inhaled corticosteroids was substantial and comparable in all GOLD stages. Use of corticosteroids was not restricted to patients with frequent exacerbations.
  
  
  CONCLUSIONS
  Polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines.
authors: Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. fritsfranssen@ciro-horn.nl
authors: Frits M E
authors: FM
authors: Franssen
authors: Martijn A
authors: MA
authors: Spruit
authors: Emiel F M
authors: EF
authors: Wouters
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004363:Drug Utilization; D005260:Female; D005541:Forced Expiratory Volume; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D019141:Respiratory System Agents / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D019141:Respiratory System Agents