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

Authors Sulku J, Janson C, Melhus H, Malinovschi A, Ställberg B, Bröms K, Högman M, Lisspers K, Hammarlund-Udenaes M, Nielsen EI

Received 8 June 2019

Accepted for publication 23 September 2019

Published 5 November 2019 Volume 2019:14 Pages 2451—2460

DOI https://doi.org/10.2147/COPD.S218747

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Justinn Cochran

Peer reviewer comments 4

Editor who approved publication: Dr Richard Russell


Johanna Sulku,1,2 Christer Janson,3 Håkan Melhus,4 Andrei Malinovschi,5 Björn Ställberg,6 Kristina Bröms,2,6 Marieann Högman,3 Karin Lisspers,6 Margareta Hammarlund-Udenaes,1 Elisabet I Nielsen1

1Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden; 2Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden; 3Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; 4Department of Medical Sciences, Clinical Pharmacogenomics and Osteoporosis, Uppsala University, Uppsala, Sweden; 5Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden; 6Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden

Correspondence: Johanna Sulku
Department of Pharmaceutical Biosciences, Faculty of Pharmacy, Uppsala University, Box 591, Uppsala SE-751 24, Sweden
Tel +46 73 635 7075
Fax +46 26 531 237
Email johanna.sulku@farmbio.uu.se

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

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