Use Patterns of Long-acting Bronchodilators in Routine COPD Care: The OUTPUL Study

Martino, Mirko Di; Agabiti, Nera; Bauleo, Lisa; Kirchmayer, Ursula; Cascini, Silvia; Pistelli, Riccardo; Colamesta, Vittoria; Patorno, Elisabetta; Pinnarelli, Luigi; Fusco, Danilo; Perucci, Carlo A.; Davoli, Marina

doi:10.3109/15412555.2013.839646

Cited by 26 publications

(31 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many patients received no treatment despite experiencing symptoms, and among those on treatment most received ICS irrespective of the severity of airflow limitation, asthma diagnosis, and exacerbation history. Several other studies have reported undertreatment with bronchodilators in comparison with ICS [9,13], or a majority of patients receiving LABA/ICS without LAMA [16]. Rather few studies have investigated temporal change in treatment patterns, but our results of decreased proportions of patients with sole ICS treatment or no maintenance treatment at all over time are consistent with a study of COPD patients in UK primary care [12].…”

Section: Discussionsupporting

confidence: 87%

“…There is extensive scientific knowledge of the treatment effects of LAMA or LABA therapy as well as the combinations LAMA + LABA, LABA + ICS, and triple inhaled therapy with LAMA, LABA, and ICS, on exacerbation frequency and health-related quality of life [5–8]. However, previous studies have shown that the prescription pattern differs and does not always follow guidelines [9–16]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

View full text Add to dashboard Cite

Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment. Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor’s diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy. Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy. Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…The average adherence rates in clinical trials have been estimated to be around 70–90% among COPD patients; however, in clinical practice, these rates are only in the range of 20–60% . In our previous work on 11 452 COPD patients in Lazio region with 2‐year follow‐up on drug treatment after discharge, only 34.8% received long‐acting bronchodilators continuously . Then, under real‐life conditions non‐adherence to medication regimens may represent a significant barrier to the optimal management of COPD patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature there is no consensus on acceptable therapy adherence, with definitions varying from >70% to >80% in clinical research settings. We decided to set the limit for optimal adherence at ≥75%, which is between these two definitions according to previous studies . See the Appendix for details on respiratory drugs ATC codes.…”

Section: Methodsmentioning

confidence: 99%

“…During the follow‐up, the days spent for severe or moderate COPD exacerbations or cardiovascular hospitalizations (ICD9CM codes 390–459 main diagnosis) were measured. Moreover, the regular use of cardiac therapies, antihypertensives or statins during follow‐up was measured (PDC ≥ 75%) . The year of enrollment was also introduced as potential confounder.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The impact of adherence to inhaled drugs on 5‐year survival in COPD patients: a time dependent approach

Belleudi¹,

Martino²,

Cascini³

et al. 2016

Pharmacoepidemiology and Drug

Self Cite

View full text Add to dashboard Cite

PurposeWhether inhaled medications improve long‐term survival in Chronic Obstructive Pulmonary Disease (COPD) is an open question. The purpose of this study is to assess the impact of adherence to inhaled drug use on 5‐year survival in COPD.MethodsA population‐based cohort study in three Italian regions was conducted using healthcare linked datasets (hospitalization, mortality, drugs). Individuals (45+ years) discharged after COPD exacerbation in 2006–2009 were enrolled. Inhaled drug daily use during 5‐year follow‐up was determined through Proportion of Days Covered on the basis of Defined Daily Doses. Five levels of time‐dependent exposure were identified: (i) long‐acting β2 agonists and inhaled corticosteroids (LB/ICS) regular use; (ii) LB/ICS occasional use; (iii) LB regular use; (iv) LB occasional use; and (v) respiratory drugs other than LB. Cox regression models adjusted for baseline (socio‐demographic, comorbidities, drug use) and time‐dependent characteristics (COPD exacerbations, cardiovascular hospitalizations, cardiovascular therapy) were performed.ResultsA total of 12 124 individuals were studied, 46% women, mean age 73,8 years. Average follow‐up time 2,4 year. A total of 3415 subjects died (mortality rate = 11.9 per 100 person years). In comparison to LB/ICS regular use, higher risks of death for all remaining treatments were found, the highest risk for respiratory drugs other than LB category (HR = 1.63, 95%CI 1.43–1.87). Patients with regular LB use had higher survival than those with LB/ICS occasional use (HR = 0.89, 95%CI 0.79–0.99).ConclusionsThese findings support clinical guidelines and recommendations for the regular use of inhaled drugs to improve health status and prognosis among moderate–severe COPD patients. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

show abstract

One‐year mortality associated with COPD treatment: a comparison of tiotropium and long‐acting beta2‐agonists in three Italian regions: results from the OUTPUL study

Kirchmayer¹,

Cascini²,

Agabiti³

et al. 2016

Pharmacoepidemiology and Drug

Self Cite

View full text Add to dashboard Cite

PurposeLong‐acting bronchodilators, i.e. beta‐2‐agonists (LABA) and tiotropium are commonly used in COPD treatment. Choice of a specific agent is based on effectiveness and safety. Evidence yields controversial results with respect to mortality. The present study compared one‐year mortality associated to treatment with tiotropium versus LABA.MethodsA population‐based cohort study using data from Italian health information systems was performed. Patients aged 45+ years, discharged with COPD diagnosis in 2006–2009 were identified. Through record linkage with drug claims, patients who received a first prescription of LABA or tiotropium within 6 months after discharge were enrolled. The main analysis was restricted to naïve users (no prior use of either LABA or tiotropium). We used ‘intention to treat’ (ITT) and ‘as treated’ (AT) approaches. We followed patients for a maximum of 12 months. Hazard ratios (HRs) were calculated by Cox regression including quintiles of propensity score. In sensitivity analysis patients receiving tiotropium + LABA combination were included in the tiotropium group.ResultsAmong the 33 891 enrolees, 28% were exposed to Tio, 56% to LABA, 16% to both. Overall mean age was 74 years and the mortality rate was 122/1000 person‐years (py) at the ITT analysis and 108/1000 py at the AT analysis. The adjusted HR for tiotropium only compared with LABA only was 1.06 (95%CI: 0.94–1.20) at the ITT analysis and 1.00 (95%CI: 0.93–1.08) at the AT analysis. Results were robust in sensitivity analysis.ConclusionsIn this real‐world study use of tiotropium was not associated with an increased risk of one‐year mortality compared with LABA. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd.

show abstract

Use Patterns of Long-acting Bronchodilators in Routine COPD Care: The OUTPUL Study

Cited by 26 publications

References 26 publications

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

The impact of adherence to inhaled drugs on 5‐year survival in COPD patients: a time dependent approach

One‐year mortality associated with COPD treatment: a comparison of tiotropium and long‐acting beta2‐agonists in three Italian regions: results from the OUTPUL study

Contact Info

Product

Resources

About