Skip to main content
SpringerLink
Log in

Deciphering patterns of respiratory medication use in Ireland to target interventions appropriately: a focus on COPD

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. O'Connor M, Hurley E, McCormack S, O'Connor T (2018) Irish Thoracic Society. Respiratory Health of the Nation Report, Dublin

  2. GBD 2015 Chronic Respiratory Disease Collaborators (2017) Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 5(9):691–706

    Article  Google Scholar 

  3. Global Initiative for Chronic Obstructive Lung Disease (2018) global strategy for the diagnosis, management and prevention of chronic obstructive lung disease. Available at: https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf

  4. Gibson G, Loddenkemper R., Lundbäck B, Sibille Y (2013) The European Lung White book; Respiratory Health and Disease in Europe. Chapter 13, Chronic obstructive pulmonary disease: European Respiratory Society. Available from: https://www.erswhitebook.org/chapters/chronic-obstructive-pulmonary-disease/. Accessed 13 January 2020

  5. Sheridan A, O’Farrell A, Evans DS, Kavanagh P (2018) Adult smoking in Ireland: a special analysis of the Healthy Ireland survey and the Irish longitudinal study on ageing (TILDA). Tobacco Free Ireland Programme, Health Service Executive, Dublin

  6. National Clinical Programme for Respiratory (2019) End to End COPD Model of Care. Dublin, Ireland Available at: https://www.hse.ie/eng/about/who/cspd/ncps/copd/moc/end-to-end-copd-model-of-care-december-2019.pdf. Accessed 13 January 2020

  7. White P, Thornton H, Pinnock H, Georgopoulou S, Booth HP (2013) Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study. PLoS One 8(10):e75221

    Article  CAS  Google Scholar 

  8. Drivenes E, Ostrem A, Melbye H (2014) Predictors of ICS/LABA prescribing in COPD patients: a study from general practice. BMC Fam Pract 15:42

    Article  Google Scholar 

  9. Cataldo D, Derom E, Liistro G, Marchand E, Ninane V, Peché R, Slabbynck H, Vincken W, Janssens W (2018) Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice. Int J Chronic Obstruct Pul Dis 13:2089–2099

    Article  CAS  Google Scholar 

  10. Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, Yates JC, Vestbo J, TORCH investigators (2007) Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 356(8):775–789

    Article  CAS  Google Scholar 

  11. Drummond MB, Dasenbrook EC, Pitz MW, Murphy DJ, Fan E (2008) Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis. Jama. 300(20):2407–2416

    Article  CAS  Google Scholar 

  12. Singh S, Amin AV, Loke YK (2009) Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis. Arch Intern Med 169(3):219–229

    Article  Google Scholar 

  13. Hurley E (2018) Trends in hospitalisations in Ireland for Chronic Obstructive Pulmonary Disease (COPD), 2009–2017. Report prepared for the COPD National Clincial Programme. Trinity College Dublin, Ireland

  14. Sinnott S-J, Bennett K, Cahir C (2017) Pharmacoepidemiology resources in Ireland-an introduction to pharmacy claims data. Eur J Clin Pharmacol 73(11):1449–1455

    Article  CAS  Google Scholar 

  15. Cramer JA, Bradley-Kennedy C, Scalera A (2007) Treatment persistence and compliance with medications for chronic obstructive pulmonary disease. Can Respir J 14(1):25–29

    Article  Google Scholar 

  16. Atsou K, Chouaid C, Hejblum G (2011) Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review. BMC Med 9(1):7

    Article  Google Scholar 

  17. Rycroft CE, Heyes A, Lanza L, Becker K (2012) Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J Chron Obstruct Pulmon Dis 7:457–494

    Article  Google Scholar 

  18. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM et al (2007) International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet (London, England) 370(9589):741–750

    Article  Google Scholar 

  19. DeMeo DL, Ramagopalan S, Kavati A, Vegesna A, Han MK, Yadao A, Wilcox TK, Make BJ, COPDGene Investigators (2018) Women manifest more severe COPD symptoms across the life course. Int J Chron Obstruct Pulmon Dis 13:3021–3029

    Article  Google Scholar 

  20. Sorheim IC, Johannessen A, Gulsvik A, Bakke PS, Silverman EK, DeMeo DL (2010) Gender differences in COPD: are women more susceptible to smoking effects than men? Thorax. 65(6):480–485

    Article  Google Scholar 

  21. Prescott E, Bjerg AM, Andersen PK, Lange P, Vestbo J (1997) Gender difference in smoking effects on lung function and risk of hospitalization for COPD: results from a Danish longitudinal population study. Eur Respir J 10(4):822–827

    CAS  PubMed  Google Scholar 

  22. Department of Health (2018) Healthy Ireland Survey 2018. Summary of findings. Dublin

  23. Brown C, Barron TI, Bennett K, MacDonald D, Dwane F, Sharp L (2016) Generalisability of pharmacoepidemiological studies using restricted prescription data. Ir J Med Sci 185(3):723–727

    Article  CAS  Google Scholar 

  24. Bloom C, Elkin SL, Quint JK (2019) Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016. Int J Chronic Obstruct Pul Dis 14:279–287

    Article  Google Scholar 

  25. Chalmers JD, Tebboth A, Gayle A, Ternouth A, Ramscar N (2017) Determinants of initial inhaled corticosteroid use in patients with GOLD A/B COPD: a retrospective study of UK general practice. npj Primary Care Respir Med 27(1):43

    Article  Google Scholar 

  26. Magnussen H, Disse B, Rodriguez-Roisin R, Kirsten A, Watz H, Tetzlaff K, Towse L, Finnigan H, Dahl R, Decramer M, Chanez P, Wouters EFM, Calverley PMA (2014) Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med 371(14):1285–1294

    Article  Google Scholar 

  27. Tariq SM, Thomas EC (2017) Maintenance therapy in COPD: time to phase out ICS and switch to the new LAMA/LABA inhalers? Int J Chronic Obstruct Pulmon Dis 12:1877–1882

    Article  CAS  Google Scholar 

  28. Riordan DO, Hurley E, Sinnott C, Galvin R, Dalton K, Kearney PM, Halpin JD, Byrne S (2019) Pharmacist-led academic detailing intervention in primary care: a mixed methods feasibility study. Int J Clin Pharm 41(2):574–582

    Article  Google Scholar 

  29. Avorn J, Soumerai SB (1983) Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based “detailing”. N Engl J Med 308(24):1457–1463

    Article  CAS  Google Scholar 

  30. Langaas HC, Hurley E, Dyrkorn R, Spigset O (2019) Effectiveness of an academic detailing intervention in primary care on the prescribing of non-steroidal anti-inflammatory drugs. Eur J Clin Pharmacol 75(4):577–586

    Article  CAS  Google Scholar 

  31. Anthierens S, Verhoeven V, Schmitz O, Coenen S (2017) Academic detailers’ and general practitioners’ views and experiences of their academic detailing visits to improve the quality of analgesic use: process evaluation alongside a pragmatic cluster randomized controlled trial. BMC Health Serv Res 17(1):841

    Article  Google Scholar 

  32. Bruyndonckx R, Verhoeven V, Anthierens S, Cornelis K, Ackaert K, Gielen B, et al. (2018) The implementation of academic detailing and its effectiveness on appropriate prescribing of pain relief medication: a real-world cluster randomized trial in Belgian general practices. Implement Sci [Internet]. 2018/01//; 13(1):[6 p.]. https://doi.org/10.1186/s13012-017-0703-8

  33. Hartung DM, Hamer A, Middleton L, Haxby D, Fagnan LJ (2012) A pilot study evaluating alternative approaches of academic detailing in rural family practice clinics. BMC Fam Pract 13:129

    Article  Google Scholar 

  34. Jenkins CR, Chapman KR, Donohue JF, Roche N, Tsiligianni I, Han MK (2017) Improving the management of COPD in women. Chest. 151(3):686–696

    Article  Google Scholar 

  35. Watson L, Vestbo J, Postma DS, Decramer M, Rennard S, Kiri VA, Vermeire PA, Soriano JB (2004) Gender differences in the management and experience of chronic obstructive pulmonary disease. Respir Med 98(12):1207–1213

    Article  Google Scholar 

  36. Ancochea J, Miravitlles M, Garcia-Rio F, Munoz L, Sanchez G, Sobradillo V et al (2013) Underdiagnosis of chronic obstructive pulmonary disease in women: quantification of the problem, determinants and proposed actions. Arch Bronconeumol 49(6):223–229

    Article  Google Scholar 

  37. Alosa Health (2017) Helping patients with COPD breathe easier. Alosa Health, Boston

    Google Scholar 

  38. Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study group (2010) Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines. Int J Chronic Obstruct Pulmon Dis 5:73–79

    Article  Google Scholar 

  39. Smith C, Hill S, Amos A (2018) Stop smoking inequalities: a systematic review of socioeconomic inequalities in experiences of smoking cessation interventions in the UK. Cancer Research UK, UK

    Google Scholar 

  40. Central Statistics Office (2019) Available from: https://www.cso.ie/en/releasesandpublications/ep/p-wamii/womenandmeninireland2016/health/. Accessed 13 January 2020

  41. Global Asthma Network (2018) The global asthma report. Auckland, New Zealand

  42. Bednarek M, Maciejewski J, Wozniak M, Kuca P, Zielinski J (2008) Prevalence, severity and underdiagnosis of COPD in the primary care setting. Thorax. 63(5):402–407

    Article  CAS  Google Scholar 

  43. Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, Burney P, Miravitlles M, García-Rio F, Akbari K, Ancochea J, Menezes AM, Perez-Padilla R, Montes de Oca M, Torres-Duque CA, Caballero A, González-García M, Buist S, BOLD Collaborative Research Group, the EPI-SCAN Team, the PLATINO Team, and the PREPOCOL Study Group (2015) Determinants of underdiagnosis of COPD in national and international surveys. Chest. 148(4):971–985

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland

    Eimir Hurley & Charles Normand

  2. Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK

    Sarah-Jo Sinnott

  3. Respiratory Physician, School of Medicine, University College Dublin, Dublin, Ireland

    Tim McDonnell

  4. The Adelaide & Meath Hospital Dublin (Tallaght), Dublin, Ireland

    Tim Delaney

  5. Department of Public Health, Health Services Executive, Dublin, Ireland

    Maire O’Connor

Authors
  1. Eimir Hurley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah-Jo Sinnott
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tim McDonnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tim Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maire O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles Normand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eimir Hurley.

Ethics declarations

This research relied exclusively on secondary use of de-identified data provided by the data custodians. The dissemination of the results of this study does not generate any identifiable information. Hence, ethics approval was deemed not applicable for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Supplemental Figure 1.

Percentage of Ireland’s population that smoke—by gender, age and deprivation, 2018. Source: Graphic created from data provided in Page 24 of Healthy Ireland Survey Summary Report 2018. (PNG 33 kb)

ESM 2

(PDF 131 kb)

ESM 3

(PDF 199 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hurley, E., Sinnott, SJ., McDonnell, T. et al. Deciphering patterns of respiratory medication use in Ireland to target interventions appropriately: a focus on COPD. Ir J Med Sci 190, 1103–1109 (2021). https://doi.org/10.1007/s11845-020-02409-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02409-x

Keywords

Search

Navigation