Are COPD prescription patterns aligned with guidelines? a population-based study

Background: In contemporary guidelines for the Chronic Obstructive Pulmonary Disease (COPD), the history of acute exacerbations plays an important role in the choice of therapies. Aim: to evaluate population-level trends of inhaled prescriptions over the time course of COPD and their relation to exacerbations history. Method: Using administrative health databases in British Columbia, Canada (1997–2015), we quantified long-acting inhaled medication use in an incident cohort, and documented its trend over the time course of COPD. We investigated the association between the frequent exacerbator status and prescriptions (by general practitioners (GP) and respirologists) using generalized linear models. Results: 132,004 patients were included (mean age 68.6, 49.2% female). The most common medication class was inhaled corticosteroids (ICS, used by 49.9%), followed by long-acting beta-agonists (LABA) and Long-acting muscarinic agents (LAMA). ICS+LABA was the most common combination therapy (30.7%). The association between exacerbation history was the most pronounced for triple therapy with odds ratio of 2.68 after a visit to a GP and 2.02 after a specialist visit (Figure). Conclusions: We documented low utilization of monotherapies and high utilization of combination therapies (ICS containing). Overall, this real-world study of prescription patterns highlights potentially significant departures from the current pharmacotherapy guidelines.