Characteristics of patients with COPD newly prescribed a long-acting bronchodilator: a retrospective cohort study

Abstract

IntroductionThis study aimed to characterize patients with chronic obstructive pulmonary disease (COPD) newly prescribed a long-acting bronchodilator (LABD), and to assess changes in medication over 24 months.MethodsA cohort of patients with COPD aged ≥40 years newly prescribed an LABD between January 1, 2007 and December 31, 2009 were identified from the Truven Marketscan® Commercial Database (Truven Health Analytics, Ann Arbor, MI, USA) and followed for 24 months. Inclusion criteria included no prior prescription for an LABD or inhaled corticosteroids for 12 months prior to the LABD index date (baseline). Patient characteristics were examined. As LABDs were mainly long-acting muscarinic antagonists (LAMAs), additions, switches, discontinuation, adherence to (medication possession ratio), and persistence (proportion of days covered) with LAMA monotherapy were assessed for 24 months following the index date. Adherence and persistence with long-acting β2-agonists (LABAs) were also assessed.ResultsA cohort of 3,268 patients aged 40–65 years was identified (mean age 55.8 years, 48% male). LAMA monotherapy was prescribed to 93% of patients who received an LABD. During the 24-month follow-up, 16% of these patients added COPD medication, 10% switched to an inhaled corticosteroid-containing medication, and 25% discontinued after one LAMA prescription at baseline. Over 12 and 24 months, adherence to LAMA was 40% and 33%, respectively, and adherence to LABA was 29% and 24%, respectively. Over the same time periods, persistence with LAMA monotherapy was 19% and 15%, respectively, and persistence with LABA was 9% and 7%, respectively.ConclusionAdherence to newly initiated LAMA monotherapy was low, with one in four patients adding to or switching from LAMA and many patients discontinuing therapy. Adherence to LABA was also low. These results suggest that additional medication to a single LABD may be required in some patients with COPD to achieve optimal disease control.

The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK

“…In our study, it was observed that within 2 years of initiating treatment for COPD, ICS therapy was added to 43% of patients on LABA or LAMA monotherapy, despite the low rate of exacerbations. This may reflect inappropriate initiation of ICS as previously described and is in line with the findings from other studies 16,17…”

Patterns of use of long‐acting bronchodilators in patients with COPD: A nationwide follow‐up study of new users in New Zealand

“…The overall finding of this study—that the prescribing of long‐acting bronchodilators and ICSs in patients with COPD does not appear to align with GOLD guidelines—is consistent with recent studies based on subgroups of patients in a variety of settings. Our observation that the most commonly dispensed first regimen involving a long‐acting bronchodilator was a LABA in combination with an ICS is consistent with findings from Spain, the Netherlands and some, but not all, studies based in the UK.…”

“…In several studies, researchers have had access to detailed clinical information which enabled them to assess the appropriateness of ICS use and subsequently conclude that ICS therapy was being overused . In line with our findings, previous investigations have also observed the use of ICS monotherapy in patients with COPD, including studies based on primary care databases in the UK and Spain, patients attending respiratory clinics in Italy, patients followed after discharge from hospital with a diagnosis of COPD in Italy and members of a health insurance database in the USA . Future studies may need to account for prescribing practices related to sub‐phenotypes of COPD, such as overlap syndromes, in which ICS may be prescribed at an earlier stage …”

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

“…Historically, use of and adherence to COPD maintenance medications has been suboptimal, with many individuals with COPD not receiving any maintenance medications (14,15,17). Among individuals who use COPD medications, adherence is low, which poses difficulties in medication management (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In this study, we found that only 22% of the sample achieved adherence of at least 80%, regardless of depression status.…”

“…Maintenance medications, including inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics, have been shown to reduce exacerbations and improve lung function and health-related quality of life among patients with moderate to severe disease (5)(6)(7). Nonetheless, use of and adherence to COPD maintenance medications remain low, ranging from 29 to 56%, and contribute to increased hospitalization, health care costs, and mortality (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”