title: Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: in UK primary care: a real-world, retrospective, observational.
abstract: Prescribing patterns in chronic obstructive pulmonary disease (COPD) are often inconsistent with published guidelines. This retrospective, observational study utilised data from the Optimum Patient Care Research Database to examine the changes in COPD prescribing patterns over time and to identify predictors of physician treatment choice for patients newly diagnosed with COPD. Initial therapy was defined as the treatment(s) prescribed at or within 1 year before COPD diagnosis. Changes over time were assessed in three cohorts based on the date of diagnosis: (1) 1997-2001; (2) 2002-2006; and (3) 2007-2010. Factors affecting the odds of being prescribed any initial therapy or any initial maintenance therapy were identified by univariable and multivariable logistic regression. The analysis included 20,154 patients, 45% of whom were prescribed an initial regimen containing an inhaled corticosteroid (ICS), whereas 28% received no initial pharmacological treatment. Prescribing of ICS monotherapy decreased over time, as did the proportion of patients receiving no therapy at or within 1 year before diagnosis. Comorbid asthma, a high exacerbation rate, increased symptoms and poor lung function each increased the likelihood of being prescribed any initial therapy or initial maintenance therapy; comorbid asthma and an annual rate of ⩾3 exacerbations were the strongest predictors. In conclusion, our analyses revealed major differences between actual prescribing behaviour and guideline recommendations for patients with newly diagnosed COPD, with many patients receiving no treatment and large numbers of patients receiving ICS-containing regimens. Predictors of initial therapy were identified.
authors.affiliation: Box Surgery, Corsham, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Gruffydd-Jones
authors.affiliation: Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.|Erasmus Medical Center, Department of Epidemiology and Respiratory Medicine, Rotterdam, The Netherlands.
authors.forename: Guy
authors.initials: G
authors.lastname: Brusselle
authors.affiliation: Centre for Clinical Trials and Population Research, 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: Novartis Pharmaceuticals, Horsham, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Baldwin
authors.affiliation: Research in Real Life, Cambridge, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Research in Real Life, Cambridge, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Rigazio
authors.affiliation: Research in Real Life, Cambridge, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Davis
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Keininger
authors.affiliation: Research in Real Life, Cambridge, UK.|Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists