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Multicenter Study
. 2022 Jan 25:17:245-258.
doi: 10.2147/COPD.S342220. eCollection 2022.

Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Marc Miravitlles  1 , Miguel Roman-Rodríguez  2   3 , Xavier Ribera  4 , John Ritz  5 , José Luis Izquierdo  6   7 ; OPTI investigator’s group
Affiliations
Multicenter Study

Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Marc Miravitlles et al. Int J Chron Obstruct Pulmon Dis. .

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 [FEV1]/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.

Keywords: chronic obstructive pulmonary disease; exacerbations; inhaled corticosteroids; primary care.

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Conflict of interest statement

Marc Miravitlles has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Atriva Therapeutics, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, Spin Therapeutics, ONO Pharma, pH Pharma, Palobiofarma SL, Takeda, Novartis, Sanofi and Grifols and research grants from Grifols. Miguel Roman-Rodriguez has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Menarini, Bial, consulting fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and research grants from AstraZeneca in the last 3 years. Xavier Ribera is an employee of Boehringer Ingelheim Spain. John Ritz is an employee of Syneos Health – Boehringer Ingelheim Pharmaceuticals Inc. José Luis Izquierdo has received honoraria for consultancy, projects, and talks from AstraZeneca, Bayer, Boehringer Ingelheim, Chiesi, Glaxo, Grifols, Smith Kline, Menarini, Novartis, Orion, Pfizer, Sandoz, Teva, and Zambon. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Distribution of the population according to the blood eosinophil levels and the frequency of exacerbations for: (A) patients on ICS; (B) patients not on ICS.
Figure 3
Figure 3
Use of ICS according to (A) the GOLD groups and GESEPOC level of risk and phenotypes, and (B) patients' scales.
Figure 4
Figure 4
Forest plot of variables associated with the prescription of ICS for COPD in primary care. (A) Total population (n = 901), and (B) population with spirometry confirmed COPD (n = 539).
See this image and copyright information in PMC

References

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