Deciphering patterns of respiratory medication use in Ireland to target interventions appropriately: a focus on COPD
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ORIGINAL ARTICLE
Deciphering patterns of respiratory medication use in Ireland to target interventions appropriately: a focus on COPD Eimir Hurley 1
&
Sarah-Jo Sinnott 2 & Tim McDonnell 3 & Tim Delaney 4 & Maire O’Connor 5 & Charles Normand 1
Received: 5 August 2020 / Accepted: 15 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Ireland has the highest rates of overnight hospitalisations for COPD in the OECD, yet lacks estimates of the prevalence of this disease or its pharmacological management. We aimed to estimate the age and sex-specific prevalence of symptomatic COPD and to identify patterns of respiratory medication use to inform interventions to improve pharmacotherapy in this condition. Methods We used the national pharmacy claims database, with data on a publically insured cohort in 2016. We restricted to those aged ≥ 45 years with full eligibility for that year and examined the age and sex distribution of respiratory medications, and patterns of medication use in those suggestive of COPD. Results In this cohort, 23% filled at least one prescription for a respiratory medication; 14% of males and 16% of females received at least one dispensing of an ICS inhaler. The proportion dispensed a long-acting muscarinic receptor antagonist (LAMA) was considerably lower. Of those newly initiated on a LAMA, 24% did not receive another within 60 days of the last covered day. The prevalence of medication use suggestive of COPD was 15% in males and 16% in females. Conclusion The prevalence of medication use consistent with the management of symptomatic COPD mirrors international prevalence estimates. Several patterns raise concern: high ICS use in older adults, under use of LAMA therapy and poor persistence of those newly initiated. We recommend the development of an intervention to assist in the implementation of new national prescribing guidelines for the management of COPD. Keywords Age-sex prevalence estimates of symptomatic COPD . Compliance with prescribing guidelines
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11845-020-02409-x) contains supplementary material, which is available to authorized users. * Eimir Hurley [email protected] 1
Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
2
Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
3
Respiratory Physician, School of Medicine, University College Dublin, Dublin, Ireland
4
The Adelaide & Meath Hospital Dublin (Tallaght), Dublin, Ireland
5
Department of Public Health, Health Services Executive, Dublin, Ireland
Ireland’s rates of hospitalisations for COPD are the highest of all OECD countries [1]. Much of the morbidity associated with COPD is preventable, or manageable with affordable interventions such as appropriate pharmacotherapy [2, 3], and smoking cessation. With 40–50% of lifelong smokers likely to develop COPD [4], and smoking rates in Ireland above 20% [5], COPD
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