Overuse of triple therapy in COPD common


By Therese Chapman

29 Oct 2015

Inappropriate prescribing of inhaled corticosteroids for patients with mild to moderate COPD is common practice in Australia despite the availability of comprehensive treatment guidelines, an expert says.

Professor Greg King from the Woolcock Institute of Medical Research in Sydney said inhaled corticosteroids were often prescribed as a first-choice treatment when COPD-X guidelines from the Lung Foundation Australia stated triple therapy should be reserved for patients with severe COPD.

“The inappropriate use of ICS has cost implications and given the side effects associated with them, in particular pneumonia…there is the potential for harm,” he said.

One issue was that it could be hard for doctors to distinguish asthma from COPD, Professor King said.

“This uncertainty of diagnosis can lead to doctors prescribing ICS plus long-acting ß2-agonist bronchodilator (LABA) to cover both bases,” he told the limbic.

Professor King was commenting on the results of a UK study of over 11,000 patients with COPD which found that almost a third of were prescribed ICS after diagnosis. Of these patients, a quarter were prescribed triple therapy within one year of diagnosis regardless of GOLD classification.

The study, titled an “inevitable drift to overuse of triple therapy” found the most common prescription pathway to triple therapy was LABA plus ICS.

According to Professor King it is difficult to break prescribing habits that have been established over many years, but education is key.

“We should also remember that there are many treatment options other than simply prescribing drugs for patients with mild to moderate COPD.

Treatment guidelines recommend pulmonary rehabilitation, risk reduction and lifestyle changes,” he said.

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