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Triple inhaled therapy in COPD patients: determinants of prescription in primary care
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy; IRCCS Fondazione Policlinico “A. Gemelli”, Italy; University of Brescia, Italy.
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Number of Authors: 92019 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 154, p. 12-17Article in journal (Refereed) Published
Abstract [en]

Objective: To assess the incidence and determinants of the triple inhaled therapy in chronic obstructive pulmonary disease (COPD) primary care patients.

Methods: Data derived from the Health Search Database (HSD) gathering information on 700 Italian general practitioners. A cohort of COPD patients, prescribed for the first time with inhaled treatments, was followed-up between January 2002 and December 2014. The outcome was the first incident prescription of a triple inhaled therapy, namely the combination of inhaled corticosteroids (ICS), long-acting beta agonists (LABA), and long-acting muscarinic antagonists (LAMA). Cox regressions were used to test the association (hazard ratios, HR) between candidate determinants and the outcome.

Results: Out of 17589 patients (mean age 71.1 +/- 11.3 years; 37.4% females), 3693 (21%) were prescribed with a triple inhaled therapy during follow-up. Older age (HR=1.79 to 2.61), current and former smoking habit (HR=1.72 and 1.66), higher GOLD stage (HR=1.45 to 2.79), the number of moderate and severe COPD exacerbations (HR=1.10 to 2.63), and heart failure (HR=1.17) resulted statistically significantly associated with an increased incident prescription of the triple inhaled therapy. Female sex (HR=0.80) and some co-morbidities (HR=0.21 to 0.87) resulted negatively associated with the outcome. Furthermore, patients initially treated with LAMA (HR=1.5) and LABA/ICS (HR=1.23) were more likely to escalate to the triple therapy, than those on LABA. Conversely, patients initially treated with ICS presented a negative hazard (HR=0.72).

Conclusions: The knowledge of demographic and clinical determinants of the escalation to the triple inhaled therapy in real-world COPD patients may help clinicians to better personalize respiratory pharmacological treatments of their patients, and inform international societies that issue clinical guidelines.

Place, publisher, year, edition, pages
2019. Vol. 154, p. 12-17
Keywords [en]
COPD, Triple inhaled therapy, Primary care, Clinical guidelines
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:su:diva-172023DOI: 10.1016/j.rmed.2019.05.022ISI: 000474821800003PubMedID: 31202120OAI: oai:DiVA.org:su-172023DiVA, id: diva2:1346348
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-27Bibliographically approved

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