Use of long‐acting bronchodilators in COPD patients inconsistent with guidelines
A nationwide study has shown complex use patterns of long-acting beta2‐agonists (LABAs), long‐acting muscarinic antagonists (LAMAs) and inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD). Often, such patterns do not comply with treatment guidelines.
A total of 83,435 patients were included, with 290,400 person-years of follow-up. LABA with an ICS was the most commonly initiated regimen.
The use of ICS was inconsistent with international guidelines. Patients with infrequent and frequent exacerbations were over- and undertreated, respectively. In addition, ICS monotherapy was common.
The first regimen had a median duration of 46 days. Multiple regimens were used in many patients over time. Periods of nonuse were also usual.
“Further work is required to address the discrepancy between guidelines and prescribing practices,” the investigators said.
Patients aged ≥45 years who initiated LABA and/or LAMA therapy for COPD between 1 February 2006 and 31 December 2013 were identified using national health and pharmaceutical dispensing data.
The investigators aggregated dispensing of LABAs, LAMAs and ICSs into episodes of use of therapeutic regimens. They generated Kaplan-Meier curves, sunburst plots and sequence index plots to summarize the duration of the first regimen, the sequences in which unique regimens were used, and the patterns of use and nonuse during follow-up, respectively.
“While several studies have found that prescribing practices do not conform to COPD treatment guidelines, none have examined longitudinal patterns of use of LABA and LAMA therapy across an entire country,” the investigators noted.