Inhaled Corticosteroids Overprescribed for COPD

Cincinnati—A large percentage of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) are being prescribed maintenance therapy with inhaled corticosteroids (ICS), a practice that is not consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010 guideline recommendations, according to information presented during a poster session at the AMCP meeting. The poster was titled Prescription of Inhaled Corticosteroids and GOLD Severity Stage among Patients with Chronic Obstructive Pulmonary Disease.

The GOLD 2010 guidelines recommend that only COPD patients at high risk (severe or very severe airflow limitation and frequent exacerbations) be prescribed maintenance ICS therapy. Researchers conducted a retrospective cohort study from January 2005 to December 2009 to determine the pattern of ICS prescriptions in accordance with the GOLD 2010 guidelines.

Using the GE Centricity Electronic Medical Record database, the researchers were able to access data on 21 million patients from 45 states and 30,000 clinicians, the majority of whom were primary care (85%). A total of 6478 patients were grouped according to COPD severity based on the GOLD guidelines and then ICS use was compared across all categories.

The patient’s first spirometry test date was used as the index date. No spirometry testing could be done 1 year after this date. In order to be eligible for study inclusion, patients had to have a diagnosis of COPD preindex without any diagnosis of asthma. Spirometry values were used to stage COPD (Table).

More than half (59%) of the patients were >65 years of age and 48% were women, with a mean forced expiratory volume in 1 second (FEV₁) percentage predicted of 63%. Among the total number of patients, 24% were categorized as having mild COPD, 42% as moderate, 25% as severe, and 9% as very severe. Results showed ICS were prescribed for 35% (n=554) of patients with mild COPD and 39% (n=1073) of patients with moderate COPD (Table).

Limitations of the study included possible inaccuracies in data entry and/or missing data. Additionally, most of the physicians included in the study were primary care physicians and thus may have had different prescribing patterns than specialists.

In conclusion, the researchers said, “A high percentage of patients in mild-moderate COPD were prescribed ICS by their physicians in the GE Centricity Electronic Medical Record database. Use of ICS in these stages of COPD is inconsistent with the GOLD 2012 guideline recommendations. This corresponds to GOLD 2011 lung function staging, which is one component of risk assessment in the new guidelines.”

This study was supported by Novartis Pharmaceuticals Corporation.