Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Abstract

Purpose Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain. Patients and Methods This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV 1 ]/forced vital capacity [FVC] ratio <70%). Multivariable logistic regression was used to identify factors associated with ICS use. Results A total of 901 patients were included, of which 47.9% (n = 432) were treated with ICS. A total of 240 patients (26.6%) experienced moderate/severe exacerbations in the prior year, while 309 (34.3%) during the previous two years. History of asthma totaled 11.6% (n = 105). The most frequent phenotype was non-exacerbator (51.6%), and the proportion of patient with moderate or severe exacerbations was significantly higher among ICS treated patients compared to non-treated: 37.5% versus 16.6% during the previous year (p < 0.001), and 46.8% versus 22.8% during the previous 2-years (p < 0.001), respectively. Patient characteristics were similar among spirometry confirmed patients and the overall population. Factors significantly associated with ICS use were a history of asthma (OR = 4.39, 95% CI: 2.67–7.26), the presence of moderate or severe exacerbations in the last year (OR = 2.52, 95% CI: 1.81–3.49), followed by higher mMRC and higher CAT score. Conclusion Nearly half of patients in primary care in Spain are treated with ICS, despite most of them being non-exacerbators. History of asthma, exacerbations, and worse dyspnea and CAT scores are associated with ICS use.

National Development in the Use of Inhaled Corticosteroid Treatment in Chronic Obstructive Pulmonary Disease: Repeated Cross-Sectional Studies from 1998 to 2018

“…Patients with COPD handled entirely by their PCP are invisible to us via registers because they do not have a registered ICD-10 diagnosis code. These are likely the patients with mild disease and therefore not in ICS treatment [47,52,73]: a recent study has shown that about 32% of patients with COPD in Denmark handled only by their PCP were in ICS treatment, which is considerably lower than in our study [74]. The severity threshold for COPD hospital admission and ICD-10 code registration has increased during our study period [75], which would further increase this potential bias over time.…”

“…One thing, however, is the publication of guidelines, but whether these guidelines are followed is another issue. Studies in the last decade have revealed a high use of ICS by both primary care practitioners (PCP) [47][48][49][50][51] and pulmonary specialists [34,[51][52][53]. Although some studies have indicated a prescription pattern in accordance with treatment guidelines [54,55], most studies have mainly focused on poor adherence to guidelines [48,51,52,[56][57][58].…”

Stepwise management of COPD: What is next after bronchodilation?

“…24 In another primary care study from Spain, almost half (48%) were treated with ICS, although only 27% experienced moderate or severe exacerbations in the previous year (34% during the previous 2 years). 25 A number of observational/registry studies have also been conducted in Japan. [31][32][33][34] Analysis of data from patients with COPD in the COPD Assessment in Practice (CAP) study, 65% of whom had no previous exacerbations in the last year, 31 showed that 28% of patients were treated with LABA/LAMA/ICS and 21% with LABA/ LAMA.…”

“…24 In another primary care study from Spain, almost half (48%) were treated with ICS, although only 27% experienced moderate or severe exacerbations in the previous year (34% during the previous 2 years). 25…”

“…When looking at country-specific real-world data regarding the use of LAMA, LABA, and ICS, it appears that clinicians are not always adhering to the current recommendations, as illustrated by the examples below. 1,7,9–11,24–40…”