Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
Background: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. Objectives: Our aim was to assess the prescription rate of ICS and to identify sociode...
| Autores: | , , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Conselleria de Salut i Consum del Govern de les Illes Balears |
| Repositorio: | Docusalut |
| Idioma: | inglés |
| OAI Identifier: | oai:docusalut.com:20.500.13003/10515 |
| Acceso en línea: | https://hdl.handle.net/20.500.13003/10515 |
| Access Level: | acceso abierto |
| Palabra clave: | Administration, Inhalation Male Aged, 80 and over Asthma Aged Dose-Response Relationship, Drug Spain Adrenal Cortex Hormones Pulmonary Disease, Chronic Obstructive Humans Smoking Middle Aged Cross-Sectional Studies Spirometry Primary Health Care Regression Analysis Female Multivariate Analysis Femenino Análisis Multivariante Administración por Inhalación Masculino Fumar Estudios Transversales Enfermedad Pulmonar Obstructiva Crónica Relación Dosis-Respuesta a Droga Humanos Persona de Mediana Edad Anciano Asma Anciano de 80 o más Años Corticoesteroides Atención Primaria de Salud Análisis de Regresión Espirometría España Chronic obstructive pulmonary disease treatment inhaled corticosteroids primary care quality of healthcare |
| Sumario: | Background: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. Objectives: Our aim was to assess the prescription rate of ICS and to identify sociodemographic and clinical factors associated with ICS prescription among patients with COPD, treated in Balearic primary healthcare. Methods: This cross-sectional study included all patients with a clinical COPD diagnosis, who attended a primary care centre of the Balearic Islands (Spain) during 2012. Also, a sub-population with spirometry-confirmed COPD was defined. Data were obtained on patient demographics, smoking status, spirometry, ICS prescriptions, other respiratory medication, exacerbations and comorbidities. Associations with ICS and high-dose ICS prescription were assessed using multivariate regression analyses. Results: In total, 15,440 patients were included (70% men, mean age 68.6 years), and 44.6% were prescribed ICS. The largest association with ICS prescription was asthma comorbidity (OR: 3.50; 95%CI: 3.12-3.92), followed by exacerbation history (OR: 2.23; 95%CI: 2.07-2.47). In addition, smoking status, spirometry, atopic dermatitis, allergic rhinitis and mean age were significantly (P<0.001) associated with ICS treatment. In the spirometry-confirmed population, asthma (OR: 2.89; 95%CI: 2.29-3.64) and exacerbations were also the major factors (OR: 2.85; 95%CI: 2.45-3.32) followed by severe bronchial-obstruction (OR: 2.63; 95%CI: 2.24-3.08). High-dose ICS prescription was mainly associated with severe obstruction (OR: 2.27; 95%CI: 1.93-2.68). Conclusion: The percentage of COPD patients prescribed ICS in Balearic primary care is relatively low. Asthma comorbidity, exacerbation history, severe bronchial-obstruction, smoking status and a spirometry-confirmed COPD diagnosis were significantly associated with ICS prescription. |
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