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

@entity1 @entity565 @entity1353 @entity1030
BACKGROUND: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting b2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for @entity1030 [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify @entity1030 @entity1 without @entity565 receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT. METHODS: This was a historical analysis of @entity1030 @entity1 without @entity565 from the Optimum @entity1 Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. @entity1 disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after @entity1030 diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council @entity1353 score, and exacerbation history on the pathway to TT. RESULTS: During the study period, 32% of @entity1 received TT. Of these, 19%, 28%, 37%, and 46% of @entity1 classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P<0.001). Of all @entity1 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 @entity1 on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of @entity1030 guidelines to physicians, ensuring that @entity1 receive the recommended therapy.
