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dc.contributor.authorHurst, JRen
dc.contributor.authorDilleen, Men
dc.contributor.authorMorris, Ken
dc.contributor.authorHills, Sen
dc.contributor.authorEmir, Ben
dc.contributor.authorJones, Ren

Purpose: Inappropriate use of an inhaled corticosteroid (ICS) for COPD has clinical and economic disadvantages. This retrospective analysis of The UK Health Improvement Network (THIN) database identified factors influencing treatment escalation (step-up) from a long-acting muscarinic antagonist (LAMA) to triple therapy (LAMA + long-acting β-agonist-ICS). Secondary objectives included time to step up from first LAMA prescription, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grouping (2011/2013, 2017), and Medical Research Council (MRC) grade prior to treatment escalation. Materials and methods: Data were included from 14,866 people ≥35 years old with a COPD diagnosis (June 1, 2010-May 10, 2015) and initiated on LAMA monotherapy. The most commonly used LAMA at baseline was tiotropium (92%). Results: Multivariate analysis (10,492 patients) revealed that COPD exacerbations, lower forced expiratory volume in 1 second (FEV1), "asthma", MRC grade, proactive and reactive COPD primary care, elective secondary-care contact, cough, and number of short-acting bronchodilator prescriptions were positively associated with treatment escalation (P<0.05). Being older, a current/ex-smoker, or having increased sputum symptom codes were negatively associated with treatment escalation (P<0.05). Median MRC score was 2 at baseline and 3 prior to treatment escalation. Using the last MRC reading and exacerbation history in the year prior to escalation, GOLD 2017 groupings were A 27.4%, B 37.3%, C 15.3%, and D 20%. In patients with available FEV1 measures, exacerbations, and MRC code (n=1,064), GOLD 2011/2013 groupings were A 20.4%, B 19.2%, C 24.8%, and D 35.6%. Conclusion: While the presence of COPD exacerbations seems to be the main driver for treatment escalation, according to the 2017 GOLD strategy many patients appear to be overtreated, as they would not be recommended for treatment escalation. Reviewing patients' treatment in the light of the new GOLD strategy has the potential to reduce inappropriate use of triple therapy.

dc.format.extent781 - 792en
dc.subjectGOLD 2017 groupingen
dc.subjectinhaled corticosteroiden
dc.subjectpatient overtreatmenten
dc.subjecttreatment step-upen
dc.subjectAdministration, Inhalationen
dc.subjectAdrenal Cortex Hormonesen
dc.subjectAdrenergic beta-2 Receptor Agonistsen
dc.subjectAged, 80 and overen
dc.subjectBronchodilator Agentsen
dc.subjectDatabases, Factualen
dc.subjectDisease Progressionen
dc.subjectDrug Therapy, Combinationen
dc.subjectElectronic Health Recordsen
dc.subjectForced Expiratory Volumeen
dc.subjectInappropriate Prescribingen
dc.subjectMedical Overuseen
dc.subjectMiddle Ageden
dc.subjectMultivariate Analysisen
dc.subjectMuscarinic Antagonistsen
dc.subjectProportional Hazards Modelsen
dc.subjectPulmonary Disease, Chronic Obstructiveen
dc.subjectRecovery of Functionen
dc.subjectRetrospective Studiesen
dc.subjectRisk Factorsen
dc.subjectSeverity of Illness Indexen
dc.subjectTime Factorsen
dc.subjectTreatment Outcomeen
dc.subjectUnited Kingdomen
dc.titleFactors influencing treatment escalation from long-acting muscarinic antagonist monotherapy to triple therapy in patients with COPD: a retrospective THIN-database analysis.en
dc.typeJournal Article
plymouth.publication-statusPublished onlineen
plymouth.journalInt J Chron Obstruct Pulmon Disen
plymouth.organisational-group/Plymouth/00 Groups by role
plymouth.organisational-group/Plymouth/00 Groups by role/Academics
plymouth.organisational-group/Plymouth/Faculty of Medicine and Dentistry
plymouth.organisational-group/Plymouth/Faculty of Medicine and Dentistry/Centre for Clinical Trials & Health Research
plymouth.organisational-group/Plymouth/Faculty of Medicine and Dentistry/Centre for Clinical Trials & Health Research/RC reporting group CTPS
plymouth.organisational-group/Plymouth/Faculty of Medicine and Dentistry/Collaboration for the Advancement of Medical Education Research Assessment
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS
dc.publisher.placeNew Zealanden
dc.rights.embargoperiodNot knownen
rioxxterms.typeJournal Article/Reviewen

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