title: Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns.
abstract: BACKGROUND
  Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database.
  
  
  METHODS
  This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis.
  
  
  RESULTS
  A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10).
  
  
  CONCLUSIONS
  COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms.
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Research in Real-Life Ltd, Cambridge, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: West
authors.affiliation: Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium ; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands ; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Guy
authors.initials: G
authors.lastname: Brusselle
authors.affiliation: Box Surgery, Wiltshire, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Gruffydd-Jones
authors.affiliation: Centre for Clinical Trials and Health Research - Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth UK.
authors.forename: Rupert
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of Pneumology, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: Pulmonary Unit, Cardiovascular and Thoracic Department, University and General Hospital, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Research in Real-Life Ltd, Cambridge, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hutton
authors.affiliation: Research in Real-Life Ltd, Cambridge, UK.
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Ashton
authors.affiliation: Research in Real-Life Ltd, Cambridge, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Research in Real-Life Ltd, Cambridge, UK.
authors.forename: Katsiaryna
authors.initials: K
authors.lastname: Bichel
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016208:Databases, Factual; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013147:Spirometry; D013222:State Medicine / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
keywords: COPD; UK primary-care setting; bronchodilators; inhaled corticosteroids; prescribing patterns