University of Otago researchers have found that the treatment of chronic obstructive pulmonary disease (COPD) in New Zealand frequently does not conform to international guidelines.
The disease, often known as emphysema and usually caused by smoking, is a common cause of hospital admissions and death, and affects an estimated 100,000 people in New Zealand.
The mainstays for COPD treatment are inhaled long-acting bronchodilators – long-acting beta-2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs).
In a nationwide study just published online in the journal Respirology, University of Otago researchers from the Pharmacoepidemiology Research Network followed New Zealanders with COPD from the time they first started a LABA and/or LAMA inhaler and examined their treatment patterns over time.
"We observed complex patterns of therapy: people switched between different combinations of LABA, LAMA, and steroid inhalers, and periods without treatment were common," says Dr. Jack Dummer, respiratory physician and study co-author.
"Use of long-term steroid inhalers was also inconsistent with guidelines: this type of treatment was common, and people with few flare-ups of their disease were over-treated with inhaled steroids, while people with more frequent flare-ups were under-treated."
Dr. Dummer says guidelines issued by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend the initial use of a LABA or LAMA inhaler in people with COPD who have more than occasional symptoms, and the addition of a second long-acting bronchodilator in those with persistent symptoms. For people with frequent flare-ups, the addition of a long-term inhaled steroid may reduce the number of flare-ups, but inhaled steroids have no benefit in the remaining patients with COPD.
"Recent studies in several countries have found that prescribing practice does not adhere to international or national COPD treatment guidelines", says lead author, Dr. Lianne Parkin.
"However, it was not known what was happening in New Zealand."
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Lianne Parkin et al. Patterns of use of long-acting bronchodilators in patients with COPD: A nationwide follow-up study of new users in New Zealand, Respirology (2017). DOI: 10.1111/resp.13235