Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016

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Title: Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016
Authors: Bloom, C
Elkin, S
Quint, JK
Item Type: Journal Article
Abstract: 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.
Issue Date: 22-Jan-2019
Date of Acceptance: 27-Dec-2018
ISSN: 1176-9106
Publisher: Dove Medical Press
Start Page: 279
End Page: 287
Journal / Book Title: International Journal of Chronic Obstructive Pulmonary Disease
Volume: 14
Copyright Statement: © 2019 Bloom et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
electronic healthcare records
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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