Background Ireland’s National Clinical Programmme recently produced clinical guidelines on pharmacotherapy for COPD. However, there is no coherent picture of the prevalence of COPD in Ireland, the characteristics of who is receiving medication for COPD and how prescribing aligns with best practice. In view of this, we evaluated medication dispensing data to estimate the age and sex specific prevalence of symptomatic COPD in Ireland, and to identify patterns of medication use which can be used to inform interventions to improve the management of this condition.
Methods We used the Primary Care Reimbursement Service database, a national repository of anonymised pharmacy claims for more than 40% of the Irish population who qualify for the General Medical Services (GMS) scheme; a public health insurance programme for those of lower income and those ≥70 years. We used a cohort study design with data from 2016, limiting our population to those aged ≥45 years to help remove dispensing for asthma. We examined the distribution of all respiratory medications dispensed, and then the patterns of medication use in those likely to have COPD.
Results From the GMS eligible population (aged ≥45 years) with coverage for the entire year(n=730, 832), there were 170, 950 patients dispensed at least one respiratory medication in 2016; equating to approximately 23% of the GMS population ≥45 years receiving at least one respiratory medication (21.5% of males and 25.0% of females).
The prevalence of medication use suggestive of COPD in those aged ≥45 years was 15.1% (m) and 16.2% (f). Prevalence was higher in females than males aged between 45 and 64 years (13.1% vs. 10.1%, p<0.0001); there was no gender difference in those aged 65–74 years; and prevalence was higher in males aged ≥75 years (21.7% vs. 18.9%, p<0.0001). Prevalence peaked in both sexes in the oldest age category: 21.7% (m) and 18.9% (f). There was significant inhaled corticosteroid (ICS) use, along with underuse of LAMA therapy.
Conclusion The prevalence of medication use consistent with the management of symptomatic COPD mirrors international estimates on prevalence of COPD, and in the absence of a population-based prevalence study, can be used to inform decision making. The high use of ICS, and the under use of LAMA therapy and poor adherence of those newly initiated is of concern. We recommend the development of an educational intervention for health professionals to assist in the implementation of new national prescribing guidelines for the management of COPD.
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