Programme no. 551-P
Quality Improvement
Prescription patterns in the newly diagnosed COPD patients according to severity
Carl Llor*1, Mònica Monteagudo2, Pere Simonet3, Eulàlia Borrell4, Miriam Barrecheguren5, Marc Miravitlles6, Cristina Esquinas7, Jaume J. Ferrer8
1Primary Care Centre Jaume I,Catalan Institute of Health,Tarragona,Spain, 2IDIAP Jordi Gol,Catalan Institute of Health,Barcelona,Spain, 3Primary Care Centre Viladecans-2,Catalan Institute of Health,Viladecans,Spain, 4Primary Care Centre Badalona-5,Catalan Institute of Health,Badalona,Spain, 5Pneumology,Hospital Universitari Vall d'Hebron,Barcelona,Spain, 6Pneumology,Hospital Universitari Vall d'Hebron,Barcelona,Spain, 7Pneumology,Hospital Universitari Vall d'Hebron,Barcelona,Spain, 8Pneumology,Hospital Universitari Vall d'Hebron,Barcelona,Spain
* = Presenting author
Objectives: To describe the adequacy of treatment prescribed in the newly diagnosed COPD patients according to severity.
Background: Treatment for COPD is tailored based on severity and clinical characteristics. Prescription treatment patterns in COPD patients in Primary Care may differ from guidelines recommendations.
Results: Data from 15,312 patients were analysed. At the time of diagnosis patients were classified as GOLD 1 (13.9%), GOLD 2 (55.2%), GOLD 3 (26%) or GOLD 4 (4.8%). The frequency of patients with a previous diagnosis of asthma or frequent exacerbators was similar between groups (up to 6.6% of patients with previous asthma and 24.5% of frequent exacerbators). Regarding treatment, milder patients were more likely to receive short-acting bronchodilators in monotherapy (21% of patients in GOLD 1 versus 14.8% in GOLD 4) or no treatment after diagnosis (38.7% GOLD 1 versus 13.6% GOLD 4) while patients in GOLD 4 received triple therapy more frequently comparing to GOLD 1 (36.6% versus 5.7%). Few patients were treated with double therapy consisting in LABA+LAMA (from 1.6% patients in GOLD 1 to 4% in GOLD 3). The percentage of patients treated with inhaled corticosteroids was higher in the severe groups (28.3%, 37.3%, 51.3%, 59.3% for GOLD 1 to 4 respectively).
Material/Methods: Epidemiological study with data obtained from the Information System for Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million of habitants (80% of Catalonia’s population). Newly diagnosed COPD patients in the years 2007-2012 were identified through a diagnostic algorithm, and patients with a diagnostic spirometry were included and classified based on GOLD severity stages. Information about the initial treatment patterns was collected. No information regarding mMRC or CAT was available but previous diagnosis of asthma and exacerbations during the previous year were collected.
Conclusion: Despite guidelines recommendations some GOLD 4 patients are still receiving short acting bronchodilators or no treatment at all after diagnosis. Inhaled corticosteroids are frequently prescribed, especially for severe patients irrespective of their previous history of asthma or number of exacerbations.
Points for discussion:
  1. What steps should be taken for avoiding the COPD underdiagnosis, mainly those with a more severe disease?
  2. What are the reasons that hamper an appropriate treatment of patients with COPD?
  3. Why do GPs still rely upon inhaled corticosteroids for the treatment of COPD?