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PULMONARY

COPD Management in Primary Care: An Observational, Community Pharmacy-Based Study

Postdoctoral Researcher, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium

Koen Boussery, MSPharm PhD

Postdoctoral Researcher, Faculty of Pharmaceutical Sciences, Ghent University

Els Adriaens, MS PhD

Postdoctoral Researcher, Faculty of Pharmaceutical Sciences, Ghent University

Luc Van Bortel, MD PhD

Professor of Clinical Pharmacology, Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University

Leen De Bolle, MSPharm PhD

Postdoctoral Researcher, Faculty of Pharmaceutical Sciences, Ghent University

Inge Van Tongelen, MSPharm

Research Associate, Faculty of Pharmaceutical Sciences, Ghent University

Jean-Paul Remon, MSPharm PhD

Professor of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Ghent University

Guy Brusselle, MD PhD

Professor of Respiratory Medicine, Department of Respiratory Medicine, Ghent University Hospital

Reprints: Dr. Mehuys, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences-Ghent University, Harelbekestraat 72, 9000 Ghent, Belgium, fax 32 0 9 222 82 36, els.mehuys{at}ugent.be

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management.

OBJECTIVE: To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies.

METHODS: A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale.

RESULTS: The mean age of the patients was 68.6 years; 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7%) than in patients aged 65 years or more (86.2%) (p < 0.001). Fixed combinations of inhaled corticosteroids and long-acting β₂-agonists were the most frequently used COPD medications (75.4%). About 48% of patients were underadherent (<80% adherence), 47% were adherent (80-120% adherence) and 5% were overadherent (>120% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs).

CONCLUSIONS: This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.

Key Words: COPD, disease management, pharmacotherapy, primary care

Published Online, January 26, 2010. www.theannals.com, DOI 10.1345/aph.1M481