An evaluation of early medication use for COPD: a population-based cohort study

• Published in: International journal of chronic obstructive pulmonary disease 2016-01, Vol.11 (1), p.3101-3108
• Main Authors: Falk, Jamie, Dik, Natalia, Bugden, Shawn
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Administrative Claims, Healthcare; Adrenal Cortex Hormones - administration & dosage; Adrenergic beta-2 Receptor Agonists - administration & dosage; Adult; Aged; Analysis; Antibiotics; Bronchodilator Agents - administration & dosage; Canada; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Codes; Cohort analysis; COPD; Databases, Factual; Development and progression; Drug Administration Schedule; Drug Combinations; Drug dosages; Drug Prescriptions; Drug Substitution; Drug therapy; Drug Therapy, Combination; Drug Utilization Review; Early Medical Intervention; Female; Guideline Adherence; guideline appropriate; Health care policy; Hospitals; Humans; Inappropriate Prescribing; inhaled steroids; Inhalers; Longitudinal Studies; Lung - drug effects; Lung - physiopathology; Male; Manitoba; Medical research; medication; Middle Aged; Nebulizers and Vaporizers; Original Research; Patients; Personal health; Population; Population-based studies; Practice Guidelines as Topic; Practice Patterns, Physicians; Prescriptions; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Severity of Illness Index; Steroids; Time Factors; Treatment Outcome
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S123643

The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada. A population-based cohort study of COPD medication use was conducted using administrative health care data (1997-2012). Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s) dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s) in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS) was based on exacerbation history and past medication use. Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% (