Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016.
Background
Over the past two decades, there have been significant changes in the pharmacological management of COPD, due to an explosion of inhaler trials, and timely updation of national and international guidelines. We sought to describe temporal changes in prescribing practices in the United Kingdom, and some of the factors that may have influenced them.


Patients and methods
COPD patients were identified from UK primary care nationally representative electronic healthcare records (Clinical Practice Research Datalink), between 2000 and 2016. Prescription data were described by the three maintenance inhaled medication classes used, inhaled corticosteroids (ICS), long-acting beta agonist (LABA), long-acting muscarinic antagonist (LAMA), and their combinations, dual LABA-ICS, dual LAMA-LABA, or triple therapy LABA-ICS-LAMA. Differing patient characteristics across the six different therapy regimens were measured in 2016.


Results
COPD patients were identified: 187,588 prevalent and incident inhaler users and 169,511 incident inhaler users. Since 2002, LAMA showed increasing popularity, while ICS alone exhibited an inverse trend. Triple therapy prescriptions rapidly increased as the first-line therapy until 2014 when LAMA-LABA prescriptions started to increase. By 2014, 41% of all COPD patients were maintained on triple therapy, and 13% were maintained on LAMA only. Characterizing the patients in 2016 revealed that those on triple therapy were more likely to have more severe disease, yet, over a third of patients on triple therapy had only mild disease.


Conclusion
UK prescribing practices were not in keeping with national guidelines but did appear to align with evidence from major drug trials and updated international guidelines. There has been a huge upsurge in triple therapy but incident data show this trend is beginning to reverse for initial management.
['Bloom|Chloe I|CI|', 'Elkin|S L|SL|', 'Quint|J K|JK|']
D000280:Administration, Inhalation D000305:Adrenal Cortex Hormones D058666:Adrenergic beta-2 Receptor Agonists D000368:Aged D001993:Bronchodilator Agents D016208:Databases, Factual D004338:Drug Combinations D011307:Drug Prescriptions D057286:Electronic Health Records D005260:Female D019983:Guideline Adherence D006801:Humans D008168:Lung D008297:Male D008875:Middle Aged D018727:Muscarinic Antagonists D009330:Nebulizers and Vaporizers D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D011320:Primary Health Care D029424:Pulmonary Disease, Chronic Obstructive D013997:Time Factors D016896:Treatment Outcome D006113:United Kingdom
COPD inhalers prescriptions UK electronic healthcare records