Characteristics of Undertreatment in COPD in the General Population

Ingebrigtsen, Truls Sylvan; Marott, Jacob Louis; Vestbo, Jørgen; Hallas, Jesper; Nordestgaard, Børge G.; Dahl, Morten; Lange, Peter

doi:10.1378/chest.13-0453

Cited by 33 publications

(32 citation statements)

References 22 publications

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“…It has been reported that comorbidity was associated with reduced odds of treatment with medication in COPD. 4 In this study, comorbidity was associated with higher adherence, possibly explained by a perceived increase in symptoms in patients with both COPD and comorbidity, 27 resulting in increased adherence.…”

Section: Discussionmentioning

confidence: 58%

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Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

et al. 2014

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OBJECTIVE:We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta 2 -agonists, long-acting anti-cholinergics, or long-acting beta 2 -agonists was identified in a nationwide registry. Use of medication was defined as medication dispensed during a one-year period , and adherence was calculated from dosages available in one year. KEY RESULTS: Use of fixed-dose combinations of inhaled corticosteroids with long-acting beta 2 -agonists varied from 2 % to 61 % (p<0.001, test for trend), long-acting anti-cholinergics varied from 0.4 % to 36 % (p<0.001), and long-acting beta 2 -agonists varied from 0.3 % to 11 % (p<0.001. Among utilizers of these medications, adherence varied from 29 % to 56 % (p<0.001, test for trend) across GOLD 1-4 for fixed-dose combinations of inhaled corticosteroids with long-acting beta 2 -agonists, from 51 % to 68 % (p=0.11) for long-acting anti-cholinergics, and from 25 to 62 % (p=0.01) for long-acting beta 2 -agonists. CONCLUSIONS: Use of and adherence to maintenance medication for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low.

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Section: Discussionmentioning

confidence: 58%

“…Undertreatment of COPD has been reported previously, 4 and studies have indicated that adherence to medication in COPD is low in the general population. Nevertheless, most studies have relied only on pharmaceutical databases, and have had limited clinical information.…”

Section: What Is the Major Question?mentioning

confidence: 72%

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

et al. 2014

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“…For this study, we identified 5812 individuals with COPD, defined by presence of airflow limitation (FEV 1 divided by FVC, FEV 1 /FVC<0.7), no self-reported asthma and age above 40 years 15 16. Of these, 5794 (99.7%) individuals had measurement of CRP at the examination.…”

Section: Methodsmentioning

confidence: 99%

Statin use and exacerbations in individuals with chronic obstructive pulmonary disease

Ingebrigtsen

Marott

Nordestgaard

et al. 2014

Thorax

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Background We tested the hypothesis that statin use in individuals with COPD is associated with a reduced risk of exacerbations. Methods We identified 5794 individuals with COPD and a measurement of C reactive protein (CRP) in the Copenhagen General Population Study (2003)(2004)(2005)(2006)(2007)(2008). During 3 years of follow-up we recorded exacerbations with hospital admissions or oral corticosteroid treatment. In a nested case-control design, matching on age, gender, smoking, COPD severity and comorbidity, we estimated the association between statin use and exacerbations. In addition, we examined the association between statin use and high CRP (>3 mg/L), and the association between high CRP and exacerbations during follow-up. Results Statin use was associated with reduced odds of exacerbations in crude analysis, OR=0.68 (95% CI 0.51 to 0.91, p=0.01), as well as in multivariable conditional logistic regression analysis, OR=0.67 (0.48 to 0.92, p=0.01). However, in the subgroup with the most severe COPD and without cardiovascular comorbidity, we observed a null association between statin use and exacerbations, OR=1

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“…Exacerbations in COPD were defined by a composite of hospital admissions with a discharge diagnosis of COPD in the national Danish Patient Registry24 and/or dispensed treatments with systemic corticosteroids alone or in combination with antibiotics in the national Danish Medicinal Product Registry 5 25. Linkage between the Copenhagen General Population Study and these nationwide registers were done using the unique personal civil registration system in Denmark 26.…”

Section: Methodsmentioning

confidence: 99%

Fibrinogen and α₁-antitrypsin in COPD exacerbations

Ingebrigtsen

Marott

Rode

et al. 2015

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Characteristics of Undertreatment in COPD in the General Population

Cited by 33 publications

References 22 publications

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Statin use and exacerbations in individuals with chronic obstructive pulmonary disease

Fibrinogen and α₁-antitrypsin in COPD exacerbations

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Characteristics of Undertreatment in COPD in the General Population

Cited by 33 publications

References 22 publications

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Statin use and exacerbations in individuals with chronic obstructive pulmonary disease

Fibrinogen and α1-antitrypsin in COPD exacerbations

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Product

Resources

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Fibrinogen and α₁-antitrypsin in COPD exacerbations