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COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?

In a primary care setting, our aim was to investigate characteristics of patients classified as having chronic obstructive pulmonary disease (COPD) and currently being prescribed inhaled corticosteroids (ICSs). The electronic patient record system in each participating general practice was searched...

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Autores principales: Savran, Osman, Godtfredsen, Nina, Sørensen, Torben, Jensen, Christian, Ulrik, Charlotte Suppli
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704538/
https://www.ncbi.nlm.nih.gov/pubmed/31431060
http://dx.doi.org/10.1177/1479973119867949
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author Savran, Osman
Godtfredsen, Nina
Sørensen, Torben
Jensen, Christian
Ulrik, Charlotte Suppli
author_facet Savran, Osman
Godtfredsen, Nina
Sørensen, Torben
Jensen, Christian
Ulrik, Charlotte Suppli
author_sort Savran, Osman
collection PubMed
description In a primary care setting, our aim was to investigate characteristics of patients classified as having chronic obstructive pulmonary disease (COPD) and currently being prescribed inhaled corticosteroids (ICSs). The electronic patient record system in each participating general practice was searched for patients coded as COPD (ICPC, Second Edition code R95) and treated with ICS (ACT code R03AK and R03BA, that is, ICS in combination with a long-acting β2-agonist) or ICS as monotherapy. Data, if available, on demographics, smoking habits, spirometry, COPD medication, symptom score, blood eosinophils, co-morbidity and exacerbation history were retrieved from the medical records for all identified cases. Of all patients registered in the 138 participating general practices, 12.560 (3%) were coded as COPD, of whom 32% were prescribed ICS. The final study sample comprised 2.289 COPD patients currently prescribed ICS (98% also prescribed long-acting β2-agonist), with 24% being coded as both COPD and asthma. Post-bronchodilator spirometry was available in 79% (mean forced expiratory volume in 1 second 60% pred (standard deviation (SD) 23.3)), symptom severity score in 53% (mean Medical Research Council score 2.7 (SD 1.1)) and 56% of the COPD patients had had no exacerbation in the previous year (and 45% not within the 2 previous years). Blood eosinophils were measured in 67% of the patients. Information on severity of airflow limitation was missing in 15% of the patients, and the combined information on symptom severity and exacerbation history was missing in in 46%. Most of the patients (74%) were managed only by their general practitioner. Although only one-third of the COPD patients were prescribed ICSs, our findings from this study of a large cohort of patients prescribed ICSs for COPD in general practice suggest that more detailed assessment of diagnosis and disease characteristics is likely to improve the risk–benefit ratio of maintenance therapy with ICSs in COPD patients managed in primary care.
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spelling pubmed-67045382019-08-29 COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines? Savran, Osman Godtfredsen, Nina Sørensen, Torben Jensen, Christian Ulrik, Charlotte Suppli Chron Respir Dis Original Paper In a primary care setting, our aim was to investigate characteristics of patients classified as having chronic obstructive pulmonary disease (COPD) and currently being prescribed inhaled corticosteroids (ICSs). The electronic patient record system in each participating general practice was searched for patients coded as COPD (ICPC, Second Edition code R95) and treated with ICS (ACT code R03AK and R03BA, that is, ICS in combination with a long-acting β2-agonist) or ICS as monotherapy. Data, if available, on demographics, smoking habits, spirometry, COPD medication, symptom score, blood eosinophils, co-morbidity and exacerbation history were retrieved from the medical records for all identified cases. Of all patients registered in the 138 participating general practices, 12.560 (3%) were coded as COPD, of whom 32% were prescribed ICS. The final study sample comprised 2.289 COPD patients currently prescribed ICS (98% also prescribed long-acting β2-agonist), with 24% being coded as both COPD and asthma. Post-bronchodilator spirometry was available in 79% (mean forced expiratory volume in 1 second 60% pred (standard deviation (SD) 23.3)), symptom severity score in 53% (mean Medical Research Council score 2.7 (SD 1.1)) and 56% of the COPD patients had had no exacerbation in the previous year (and 45% not within the 2 previous years). Blood eosinophils were measured in 67% of the patients. Information on severity of airflow limitation was missing in 15% of the patients, and the combined information on symptom severity and exacerbation history was missing in in 46%. Most of the patients (74%) were managed only by their general practitioner. Although only one-third of the COPD patients were prescribed ICSs, our findings from this study of a large cohort of patients prescribed ICSs for COPD in general practice suggest that more detailed assessment of diagnosis and disease characteristics is likely to improve the risk–benefit ratio of maintenance therapy with ICSs in COPD patients managed in primary care. SAGE Publications 2019-08-20 /pmc/articles/PMC6704538/ /pubmed/31431060 http://dx.doi.org/10.1177/1479973119867949 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Paper
Savran, Osman
Godtfredsen, Nina
Sørensen, Torben
Jensen, Christian
Ulrik, Charlotte Suppli
COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?
title COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?
title_full COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?
title_fullStr COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?
title_full_unstemmed COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?
title_short COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?
title_sort copd patients prescribed inhaled corticosteroid in general practice: based on disease characteristics according to guidelines?
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704538/
https://www.ncbi.nlm.nih.gov/pubmed/31431060
http://dx.doi.org/10.1177/1479973119867949
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