Management of COPD in the UK primary-care setting

an analysis of real-life prescribing patterns

David Price, Daniel West, Guy Brusselle, Kevin Gruffydd-Jones, Rupert Jones, Marc Miravitlles, Andrea Rossi, Catherine Hutton, Valerie L Ashton, Rebecca Stewart, Katsiaryna Bichel

Research output: Contribution to journalArticle

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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).

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)889-905
Number of pages17
JournalInternational journal of chronic obstructive pulmonary disease
Volume9
DOIs
Publication statusPublished - 27 Aug 2014

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Adrenal Cortex Hormones
Asthma
Therapeutics
Databases
Muscarinic Antagonists
Spirometry
National Institutes of Health (U.S.)

Keywords

  • COPD
  • UK primary-care setting
  • prescribing patterns
  • inhaled corticosteroids
  • bronchodilators

Cite this

Management of COPD in the UK primary-care setting : an analysis of real-life prescribing patterns. / Price, David; West, Daniel; Brusselle, Guy; Gruffydd-Jones, Kevin; Jones, Rupert; Miravitlles, Marc; Rossi, Andrea; Hutton, Catherine; Ashton, Valerie L; Stewart, Rebecca; Bichel, Katsiaryna.

In: International journal of chronic obstructive pulmonary disease , Vol. 9, 27.08.2014, p. 889-905.

Research output: Contribution to journalArticle

Price, D, West, D, Brusselle, G, Gruffydd-Jones, K, Jones, R, Miravitlles, M, Rossi, A, Hutton, C, Ashton, VL, Stewart, R & Bichel, K 2014, 'Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns', International journal of chronic obstructive pulmonary disease , vol. 9, pp. 889-905. https://doi.org/10.2147/COPD.S62750
Price, David ; West, Daniel ; Brusselle, Guy ; Gruffydd-Jones, Kevin ; Jones, Rupert ; Miravitlles, Marc ; Rossi, Andrea ; Hutton, Catherine ; Ashton, Valerie L ; Stewart, Rebecca ; Bichel, Katsiaryna. / Management of COPD in the UK primary-care setting : an analysis of real-life prescribing patterns. In: International journal of chronic obstructive pulmonary disease . 2014 ; Vol. 9. pp. 889-905.
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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).CONCLUSION: 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.",
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T1 - Management of COPD in the UK primary-care setting

T2 - an analysis of real-life prescribing patterns

AU - Price, David

AU - West, Daniel

AU - Brusselle, Guy

AU - Gruffydd-Jones, Kevin

AU - Jones, Rupert

AU - Miravitlles, Marc

AU - Rossi, Andrea

AU - Hutton, Catherine

AU - Ashton, Valerie L

AU - Stewart, Rebecca

AU - Bichel, Katsiaryna

PY - 2014/8/27

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N2 - 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).CONCLUSION: 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.

AB - 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).CONCLUSION: 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.

KW - COPD

KW - UK primary-care setting

KW - prescribing patterns

KW - inhaled corticosteroids

KW - bronchodilators

U2 - 10.2147/COPD.S62750

DO - 10.2147/COPD.S62750

M3 - Article

VL - 9

SP - 889

EP - 905

JO - International journal of chronic obstructive pulmonary disease

JF - International journal of chronic obstructive pulmonary disease

SN - 1176-9106

ER -