Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 10 » Issue 1

The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK

Authors Brusselle G, Price D, Gruffydd-Jones K, Miravitlles M, Keininger DL, Stewart R, Baldwin M, Jones RC

Received 3 July 2015

Accepted for publication 17 August 2015

Published 15 October 2015 Volume 2015:10(1) Pages 2207—2217

DOI https://doi.org/10.2147/COPD.S91694

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Professor Hsiao-Chi Chuang

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Guy Brusselle,1–3 David Price,4,5 Kevin Gruffydd-Jones,6 Marc Miravitlles,7 Dorothy L Keininger,8 Rebecca Stewart,5 Michael Baldwin,9 Rupert C Jones10

1Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium; 2Department of Epidemiology, 3Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands; 4Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 5Research in Real Life (RiRL), Singapore; 6Box Surgery, Wiltshire, UK; 7Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 8Novartis Pharma AG, Basel, Switzerland; 9Novartis Pharmaceuticals Limited, Horsham, UK; 10Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK

Background: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT.
Methods: This was a historical analysis of COPD patients without asthma from the Optimum Patient Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. Patient disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after COPD diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council dyspnea score, and exacerbation history on the pathway to TT.
Results: During the study period, 32% of patients received TT. Of these, 19%, 28%, 37%, and 46% of patients classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P<0.001). Of all patients prescribed TT, 25% were prescribed TT within 1 year of diagnosis, irrespective of GOLD classification (P=0.065). The most common prescription pathway to TT was LABA plus ICS. It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.
Conclusion: Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of COPD guidelines to physicians, ensuring that patients receive the recommended therapy.

Keywords: chronic obstructive pulmonary disease, GOLD guidelines, observational study, prescribing patterns, primary care

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other articles by this author:

Seasonal patterns of oral antihistamine and intranasal corticosteroid purchases from Australian community pharmacies: a retrospective observational study

Carney AS, Price DB, Smith PK, Harvey R, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner DA, Carter V, Durieux AMS

Pragmatic and Observational Research 2017, 8:157-165

Published Date: 30 August 2017

Asthma referrals: a key component of asthma management that needs to be addressed

Price D, Bjermer L, Bergin DA, Martinez R

Journal of Asthma and Allergy 2017, 10:209-223

Published Date: 25 July 2017

Cardiovascular risks in smokers treated with nicotine replacement therapy: a historical cohort study

Dollerup J, Vestbo J, Murray-Thomas T, Kaplan A, Martin RJ, Pizzichini E, Pizzichini MMM, Burden A, Martin J, Price DB

Clinical Epidemiology 2017, 9:231-243

Published Date: 26 April 2017

Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study

Voorham J, Vrijens B, van Boven JFM, Ryan D, Miravitlles M, Law LM, Price DB

Pragmatic and Observational Research 2017, 8:31-41

Published Date: 18 April 2017

An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma

Burden A, Roche N, Miglio C, Hillyer EV, Postma DS, Herings RMC, Overbeek JA, Khalid JM, van Eickels D, Price DB

Pragmatic and Observational Research 2017, 8:15-30

Published Date: 22 March 2017

The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

Bosnic-Anticevich S, Chrystyn H, Costello RW, Dolovich MB, Fletcher MJ, Lavorini F, Rodríguez-Roisin R, Ryan D, Wan Yau Ming S, Price DB

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:59-71

Published Date: 21 December 2016

Predicting frequent COPD exacerbations using primary care data

Kerkhof M, Freeman D, Jones R, Chisholm A, Price DB

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2439-2450

Published Date: 9 November 2015

Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD

Postma DS, Roche N, Colice G, Israel E, Martin RJ, van Aalderen WMC, Grigg J, Burden A, Hillyer EV, von Ziegenweidt J, Gopalan G, Price D

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:1163-1186

Published Date: 17 October 2014

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

Price D, West D, Brusselle G, Gruffydd-Jones K, Jones R, Miravitlles M, Rossi A, Hutton C, Ashton VL, Stewart R, Bichel K

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:889-905

Published Date: 27 August 2014

Impact of night-time symptoms in COPD: a real-world study in five European countries

Price D, Small M, Milligan G, Higgins V, Garcia Gil E, Estruch J

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:595-603

Published Date: 27 November 2013

Readers of this article also read:

Effect of tiotropium on lung function decline in early-stage of chronic obstructive pulmonary disease patients: propensity score-matched analysis of real-world data

Lee HY, Choi SM, Lee J, Park YS, Lee CH, Kim DK, Lee SM, Yoon HI, Yim JJ, Kim YW, Han SK, Yoo CG

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2185-2192

Published Date: 13 October 2015

Roflumilast in COPD: a Brazilian perspective

Stirbulov R, Jardim JR

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1853-1855

Published Date: 8 September 2015

Screening of COPD patients for abdominal aortic aneurysm

Flessenkaemper IH, Loddenkemper R, Roll S, Enke-Melzer K, Wurps H, Bauer TT

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1085-1091

Published Date: 10 June 2015

LANTERN: a randomized study of QVA149 versus salmeterol/fluticasone combination in patients with COPD

Zhong N, Wang C, Zhou X, Zhang N, Humphries M, Wang L, Thach C, Patalano F, Banerji D

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1015-1026

Published Date: 5 June 2015

The reasons for triple therapy in stable COPD patients in Japanese clinical practice

Miyazaki M, Nakamura H, Takahashi S, Chubachi S, Sasaki M, Haraguchi M, Terai H, Ishii M, Fukunaga K, Tasaka S, Soejima K, Asano K, Betsuyaku T

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1053-1059

Published Date: 4 June 2015

Effect of N-acetylcysteine in COPD patients with different microsomal epoxide hydrolase genotypes

Zhang JQ, Zhang JQ, Liu H, Zhao ZH, Fang LZ, Liu L, Fu WP, Shu JK, Feng JG, Dai LM

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:917-923

Published Date: 13 May 2015

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

Price D, West D, Brusselle G, Gruffydd-Jones K, Jones R, Miravitlles M, Rossi A, Hutton C, Ashton VL, Stewart R, Bichel K

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:889-905

Published Date: 27 August 2014