First maintenance therapy for COPD in the UK between 2009 and 2012: a retrospective database analysis.
Clinical guidelines recommend long-acting bronchodilators as first maintenance therapy for chronic obstructive pulmonary disease (COPD), with inhaled corticosteroids (ICS) reserved for patients with more severe disease and exacerbations. The aim of this analysis was to examine real-life prescribing of first maintenance therapy for COPD in the UK. Data were extracted from the UK Optimum Patient Care Research Database for patients with a first prescription for COPD maintenance therapy between 2009 and 2012 and a diagnosis of COPD at or before the date of the first prescription for COPD maintenance therapy. Routine clinical data including demographics, disease history and symptoms, comorbidities, therapy, hospitalisation rate and exacerbation rate were collected and used to characterise patients stratified by disease severity and Global Initiative for Chronic Obstructive Lung Disease (GOLD) group (A-D). The analysis population included 2,217 individuals (55.4% male, 45.2% smokers). Long-acting muscarinic antagonists (LAMA) as monotherapy were prescribed as first maintenance therapy for 40.2% of patients. ICS were prescribed as ICS/long-acting beta-agonists combination for 29.1% of patients or as monotherapy for 15.5%. ICS (alone or in combination) were prescribed to >40% of patients in each GOLD group. ICS-containing regimens were prescribed to patients with a history of pneumonia and comorbid conditions for whom the risks of ICS therapy may outweigh the benefits. The clinical reality of prescribing indicates that ICS are often prescribed outside current guideline recommendations for many patients newly diagnosed with COPD in the UK. Encouragingly, LAMAs are increasingly being prescribed as first maintenance therapy for these patients.
Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
David
D
Price
Department of Pneumology, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Marc
M
Miravitlles
Department of Respiratory Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
Ian
I
Pavord
Department of Primary Care Research, University of Southampton, Southampton, UK.
Mike
M
Thomas
Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK.
Jadwiga
J
Wedzicha
Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
John
J
Haughney
Research in Real-Life Ltd, Cambridge, UK.
Katsiaryna
K
Bichel
Research in Real-Life Ltd, Cambridge, UK.
Daniel
D
West
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists