A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden

Abstract

Purpose

Inhaled corticosteroids (ICS) are often more widely prescribed in the treatment of chronic obstructive pulmonary disease (COPD) than what is recommended in the guidelines. The aim of this study was to evaluate the appropriateness of ICS treatment in COPD patients using the algorithm proposed by the International Primary Care Respiratory Group (IPCRG) and to identify factors associated with ICS treatment.

Patients and methods

Appropriateness of ICS therapy was studied with respect to concomitant asthma, history of exacerbations and blood eosinophils (B-Eos) in a Swedish cohort of primary and secondary care patients with COPD. Factors associated with ICS were investigated using multivariable logistic regression.

Results

Triple treatment was found to be the most common treatment combination, used by 46% of the 561 included patients, and in total 63% were using ICS. When applying the IPCRG algorithm, there was a possible indication for discontinuation of ICS in 55% of the patients with ICS treatment. Of the patients not using ICS, 18% had an indication for starting such treatment. The strongest factors associated with ICS therapy were frequent exacerbations (aOR 8.61, 95% CI 4.06, 20.67), secondary care contacts (aOR 6.99, 95% CI 2.48, 25.28) and very severe airflow limitation (aOR 5.91, 95% CI 1.53, 26.58).

Conclusion

More than half of the COPD patients on ICS met the criteria where withdrawal of the treatment could be tried. There was, however, also a subgroup of patients not using ICS for whom there was an indication for starting ICS treatment. Patients using ICS were characterized by more frequent exacerbations and lower lung function.

Keywords:

• ICS
• pharmacological management
• inappropriate therapy
• chronic obstructive pulmonary disease
• IPCRG

Acknowledgments

The authors thank the personnel at the Dalarna, Gävleborg and Uppsala research units and statistician Sara Gustavsson for the support and guidance in statistics and Linnéa Holmén for proofreading the manuscript. This study was funded by the Uppsala-Örebro Regional Research Council, the Centre for Research & Development, Uppsala University/Region Gävleborg, the Centre for Clinical Research, Uppsala University, County Council Dalarna, the Swedish Heart-Lung Foundation, the Swedish Heart and Lung Association and the Bror Hjerpstedt Foundation.

Data Availability

Data cannot be made freely available as they are subject to secrecy in accordance with the Swedish Public Access to Information and Secrecy Act, but can be made available to researchers upon request (subject to a review of secrecy).

Author Contributions

MH, CJ, AM, BS, KB, KL and JS initiated and designed the TIE study. JS, CJ, HM, MHU and EIN contributed to the data analysis performed in this manuscript. JS had full access to the study data and takes full responsibility for the integrity of the data and the accuracy of the analysis, and wrote the first draft of the manuscript. All authors analyzed and interpreted the data, contributed with critical revision of the manuscript, approved the final version to be published, and agree to be accountable for all aspects of the work.

Disclosure

JS has received a payment for an educational activity from Orion Pharma. CJ has received payments for educational activities from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis and TEVA, and has served on advisory boards organized by AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and TEVA. BS has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Meda and TEVA and has served on advisory boards organized by AstraZeneca, Novartis, GSK, Boehringer Ingelheim, TEVA and Meda. KL has received honoraria for educational activities and lectures from AstraZeneca, Novartis, TEVA, Chiesi and GlaxoSmithKline and has served on advisory boards organized by Novartis and Boehringer Ingelheim. No potential conflicts of interests were reported by any of the other authors.