Miriam Barrecheguren1, Mónica Monteagudo2, Jaume Ferrer1, Eulalia Borrell3, Carl Llor4, Cristina Esquinas5, Marc Miravitlles6. 1. Pneumology Department, Hospital General Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. 2. IDIAP Jordi Gol, Barcelona, Spain. 3. Primary Care Center Badalona-5, Badalona, Spain. 4. Primary Care Center Via Roma, Barcelona, Spain. 5. Pneumology Department, Hospital General Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. 6. Pneumology Department, Hospital General Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Electronic address: mmiravitlles@vhebron.net.
Abstract
INTRODUCTION: Treatment for COPD is tailored based on clinical characteristics and severity. However, prescription patterns in COPD patients newly diagnosed in primary care may differ from guideline recommendations. METHOD: We performed an epidemiological study with data obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million inhabitants (80% of the population of Catalonia). Patients newly diagnosed with COPD from 2007 to 2012 were identified and information about the initial treatment patterns was collected. The initial treatment was also described by phenotype and severity. RESULTS: During the study period 41,492 patients were newly diagnosed with COPD. Patients were classified as non exacerbators (28,552 patients, 69%), asthma-COPD overlap syndrome (ACOS) (2152 patients, 5.2%) and frequent exacerbators (10,888 patients, 27.6%). Among the patients in whom FEV1 was available, 13.9% were GOLD stage 1, 55.2% stage 2, 26% stage 3 and 4.8% stage 4. Globally, the most frequently prescribed treatment patterns were short-acting bronchodilators (SABD) in monotherapy (17.7%), long-acting β-2 agonists (LABA) + inhaled corticosteroids (ICS) (17.3%) and triple therapy (12.2%). The frequency of patients treated with a SABD increased from 15.9% to 19.5% during the study period, while the number of untreated patients decreased from 24.4% to 15.1%. Up to 45.2% of patients were initially treated with ICS, which were frequently prescribed in the ACOS (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non exacerbator patients. Up to 13.6% and 14.8% of GOLD 4 patients received no treatment or only SABD after diagnosis. CONCLUSIONS: Initial treatment patterns in newly diagnosed COPD patients often do no comply with guidelines. The use of ICS is excessive but has decreased mainly in non exacerbator patients. Many COPD patients still remain untreated after diagnosis, although this has decreased. Some GOLD 4 patients are still receiving SABD or no treatment at all after diagnosis.
INTRODUCTION: Treatment for COPD is tailored based on clinical characteristics and severity. However, prescription patterns in COPDpatients newly diagnosed in primary care may differ from guideline recommendations. METHOD: We performed an epidemiological study with data obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million inhabitants (80% of the population of Catalonia). Patients newly diagnosed with COPD from 2007 to 2012 were identified and information about the initial treatment patterns was collected. The initial treatment was also described by phenotype and severity. RESULTS: During the study period 41,492 patients were newly diagnosed with COPD. Patients were classified as non exacerbators (28,552 patients, 69%), asthma-COPD overlap syndrome (ACOS) (2152 patients, 5.2%) and frequent exacerbators (10,888 patients, 27.6%). Among the patients in whom FEV1 was available, 13.9% were GOLD stage 1, 55.2% stage 2, 26% stage 3 and 4.8% stage 4. Globally, the most frequently prescribed treatment patterns were short-acting bronchodilators (SABD) in monotherapy (17.7%), long-acting β-2 agonists (LABA) + inhaled corticosteroids (ICS) (17.3%) and triple therapy (12.2%). The frequency of patients treated with a SABD increased from 15.9% to 19.5% during the study period, while the number of untreated patients decreased from 24.4% to 15.1%. Up to 45.2% of patients were initially treated with ICS, which were frequently prescribed in the ACOS (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non exacerbator patients. Up to 13.6% and 14.8% of GOLD 4 patients received no treatment or only SABD after diagnosis. CONCLUSIONS: Initial treatment patterns in newly diagnosed COPDpatients often do no comply with guidelines. The use of ICS is excessive but has decreased mainly in non exacerbator patients. Many COPDpatients still remain untreated after diagnosis, although this has decreased. Some GOLD 4 patients are still receiving SABD or no treatment at all after diagnosis.
Authors: Javier de Miguel-Díez; Rodrigo Jiménez-García; Ana López de Andrés; Fernando Zaragoza Arnáez Journal: Clin Drug Investig Date: 2019-07 Impact factor: 2.859
Authors: Claus Vogelmeier; Nanshan Zhong; Michael J Humphries; Karen Mezzi; Robert Fogel; Giovanni Bader; Francesco Patalano; Donald Banerji Journal: Int J Chron Obstruct Pulmon Dis Date: 2016-12-14