Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

Abstract

Background: Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database.

Methods: This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis.

Results: A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10).

Conclusion: COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms.

Keywords: COPD; UK primary-care setting; bronchodilators; inhaled corticosteroids; prescribing patterns.

Figure 1

Patient selection. Note: Data were extracted in May 2013. Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; OPCRD, Optimum Patient Care Research Database; QOF, quality and outcomes framework.

Figure 2

Distribution of GOLD groups in patients without and with moderate and severe exacerbations in the year prior to data extraction for total COPD population (A) and GOLD Stage 2 subset (B). Note: GOLD groups calculated without COPD Assessment Test score. Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 3

Current management for total COPD population (A) and GOLD Stage 2 subset (B) by GOLD groups. Notes: Percentages were calculated against the total number of patients in the COPD population (n=24,957) and GOLD Stage 2 subset (n=13,557). Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline. Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β₂-agonist.

Figure 4

Current management by concomitant asthma diagnosis for total COPD population (A) and GOLD Stage 2 subset (B). Note: Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline. Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β₂-agonist.

Figure 5

Current management by moderate and severe exacerbation rate in the year prior to data extraction for the GOLD Stage 2 subset. Note: Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline. Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β₂-agonist.

Figure 6

Current management by mMRC score (A) and CAT score (B) for the GOLD Stage 2 subset. Notes: mMRC scores are taken from the most recent routine data or questionnaire data to the extraction date. Other therapies include other combinations of ICS, LAMA, LABA, SAMA, SABA, LTRA, and theophylline. Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council; LTRA, leukotriene receptor antagonist; SAMA, short-acting muscarinic antagonist; SABA, short-acting β₂-agonist.