[Changing patterns of medication prescription for COPD patients in France. Impact of long-acting muscarinic antagonists' availability]

Rev Mal Respir. 2017 May;34(5):535-543. doi: 10.1016/j.rmr.2017.02.006. Epub 2017 May 31.
[Article in French]

Abstract

Introduction: We studied the pattern changes over time of medication prescriptions for COPD and their conformity with French and international recommendations using data from patients in the prospective French cohort "Initiatives BPCO".

Method: Eight hundred and forty-six patients have been included during a first period from August, 2001 till May 2006 (n=425) and a second period from June, 2006 till June, 2012 (n=421). The pivotal date was based on the tiotropium availability in France.

Results: During period 1, we recruited older patients (average 65 vs 64 years), less often women (19 vs 26 %) and having less severe airflow obstruction (mean FEV1 48 vs 54 %). The ICS prescriptions decreased in mild COPD, but there was no change for inhaled long-acting beta-2 agonist (LABA) (68 %). The use of LABA+LAMA association without ICS increased from 0.9 to 7 %, but remained lower than the fixed LABA+ICS association (26 %), less often prescribed than the triple association LABA+ICS+LAMA (32.5 % in period 2). The use of long-acting bronchodilators increased from 68 to 80 % between both periods. Vaccinations and rehabilitation remained insufficiently prescribed. LAMA had been added but did not appear to replace other drugs.

Keywords: Anticholinergics; Anticholinergiques; BPCO; Beta-2 sympathomimetics; Bronchodilatateurs; Bronchodilators; Bêta-2 sympathomimétiques; COPD; Corticostéroïdes inhalés; Inhaled corticosteroids.

MeSH terms

  • Administration, Inhalation
  • Aged
  • Biological Availability
  • Bronchodilator Agents / pharmacokinetics
  • Bronchodilator Agents / therapeutic use*
  • Delayed-Action Preparations
  • Female
  • France / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Muscarinic Antagonists / administration & dosage*
  • Muscarinic Antagonists / pharmacokinetics*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Practice Patterns, Physicians' / trends*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / metabolism

Substances

  • Bronchodilator Agents
  • Delayed-Action Preparations
  • Muscarinic Antagonists