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Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014
Örebro University, School of Medical Sciences.
School of Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences.
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.ORCID iD: 0000-0001-6328-5494
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2017 (English)In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 4, article id 1409060Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment.

Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor's diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy.

Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy.

Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.

Place, publisher, year, edition, pages
Taylor & Francis, 2017. Vol. 4, article id 1409060
Keywords [en]
LAMA, LABA, ICS, bronchodilator therapy, triple inhaled therapy, symptoms, frequent exacerbations GOLD 2017
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-63422DOI: 10.1080/20018525.2017.1409060ISI: 000417152400001OAI: oai:DiVA.org:oru-63422DiVA, id: diva2:1167737
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2017-12-19Bibliographically approved

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Sundh, JosefinHasselgren, MikaelMontgomery, Scott

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