DISCREPANCIES between guideline recommendations and the prescription of inhaled corticosteroids (ICS) in the UK suggest that these drugs may be overused in patients with chronic obstructive pulmonary disease (COPD).
ICS are recommended for use as part of a triple therapy, combined with long-acting muscarinic antagonists and/or long-acting beta-agonists, in patients with severe COPD and frequent exacerbations, but their long-term use is associated with an increased risk of diabetes, osteoporosis, and pneumonia. The new study, which included 11,858 primary care patients from the UK, found that many COPD patients are prescribed ICS immediately following initial diagnosis, which inevitably leads to them progressing to triple therapy.
Prof Guy Brusselle, Ghent University Hospital, Ghent, Belgium, said: “Despite the availability of excellent guidelines, this study shows that 28% of patients with lower-risk COPD were prescribed triple therapy at their initial COPD consultation. Furthermore, of the patients who were eventually prescribed triple therapy, over 60% received ICS in their first prescription, implying that the initial ICS prescription often leads into triple therapy even in cases where ICS is not appropriate. Primary care physicians do not always manage COPD according to the recommendations and guidelines. Inappropriate and long-term overuse of ICS and triple therapy is potentially harmful for COPD patients, especially for those who do not experience exacerbations, and is likely to increase the strain on healthcare resources. There is, therefore, an urgent need to address the issues of awareness and adherence to clinical practice guidelines among physicians, and to review the dissemination and implementation of guidelines in the future.”
The study outlines a number of routes that can cause inappropriate prescriptions to be made, which may hopefully lead to a re-evaluation of the use of ICS and result in more patients receiving the most appropriate treatment. Avoiding extra complications is obviously beneficial for patients living with chronic COPD, with triple therapy being reserved for use only in patients with severe disease and frequent exacerbations.