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Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study

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Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs : cross-sectional observational study. / White, Patrick; Thornton, Hannah; Pinnock, Hilary; Georgopoulou, Sofia; Booth, Helen P.

In: PLoS ONE, Vol. 8, No. 10, e75221, 23.10.2013.

Research output: Contribution to journalArticle

Harvard

White, P, Thornton, H, Pinnock, H, Georgopoulou, S & Booth, HP 2013, 'Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study', PLoS ONE, vol. 8, no. 10, e75221. https://doi.org/10.1371/journal.pone.0075221

APA

White, P., Thornton, H., Pinnock, H., Georgopoulou, S., & Booth, H. P. (2013). Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study. PLoS ONE, 8(10), [e75221]. https://doi.org/10.1371/journal.pone.0075221

Vancouver

White P, Thornton H, Pinnock H, Georgopoulou S, Booth HP. Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study. PLoS ONE. 2013 Oct 23;8(10). e75221. https://doi.org/10.1371/journal.pone.0075221

Author

White, Patrick ; Thornton, Hannah ; Pinnock, Hilary ; Georgopoulou, Sofia ; Booth, Helen P. / Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs : cross-sectional observational study. In: PLoS ONE. 2013 ; Vol. 8, No. 10.

Bibtex Download

@article{9001c5bf4768406ca6eaecd29ffdc890,
title = "Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study",
abstract = "IntroductionCombined inhaled long-acting beta-agonists and corticosteroids (LABA+ICS) are costly. They are recommended in severe or very severe chronic obstructive pulmonary disease (COPD). They should not be prescribed in mild or moderate disease. In COPD ICS are associated with side-effects including risk of pneumonia. We quantified appropriateness of prescribing and examined the risks and costs associated with overuse.MethodsData were extracted from the electronic and paper records of 41 London general practices (population 310,775) including spirometry, medications and exacerbations. We classified severity, assessed appropriateness of prescribing using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for 2009, and performed a sensitivity analysis using the broader recommendations of the 2011 revision.Results3537 patients had a diagnosis of COPD. Spirometry was recorded for 2458(69%). 709(29%) did not meet GOLD criteria. 1749(49%) with confirmed COPD were analysed: 8.6% under-treated, 38% over-treated. Over-prescription of ICS in GOLD stage I or II (n=403, 38%) and in GOLD III or IV without exacerbations (n=231, 33.6%) was common. An estimated 12 cases (95%CI 7-19) annually of serious pneumonia were likely among 897 inappropriately treated. 535 cases of overtreatment involved LABA+ICS with a mean per patient cost of £553.56/year (€650.03). Using the broader indications for ICS in the 2011 revised GOLD guideline 25% were still classified as over-treated. The estimated risk of 15 cases of pneumonia (95%CI 8-22) in 1074 patients currently receiving ICS would rise by 20% to 18 (95%CI 9.8-26.7) in 1305 patients prescribed ICS if all with GOLD grade 3 and 4 received LABA+ICS.ConclusionOver-prescription of ICS in confirmed COPD was widespread with considerable potential for harm. In COPD where treatment is often escalated in the hope of easing the burden of disease clinicians should consider both the risks and benefits of treatment and the costs where the benefits are unproven.",
author = "Patrick White and Hannah Thornton and Hilary Pinnock and Sofia Georgopoulou and Booth, {Helen P}",
year = "2013",
month = oct,
day = "23",
doi = "10.1371/journal.pone.0075221",
language = "English",
volume = "8",
journal = "PL o S One ",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs

T2 - cross-sectional observational study

AU - White, Patrick

AU - Thornton, Hannah

AU - Pinnock, Hilary

AU - Georgopoulou, Sofia

AU - Booth, Helen P

PY - 2013/10/23

Y1 - 2013/10/23

N2 - IntroductionCombined inhaled long-acting beta-agonists and corticosteroids (LABA+ICS) are costly. They are recommended in severe or very severe chronic obstructive pulmonary disease (COPD). They should not be prescribed in mild or moderate disease. In COPD ICS are associated with side-effects including risk of pneumonia. We quantified appropriateness of prescribing and examined the risks and costs associated with overuse.MethodsData were extracted from the electronic and paper records of 41 London general practices (population 310,775) including spirometry, medications and exacerbations. We classified severity, assessed appropriateness of prescribing using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for 2009, and performed a sensitivity analysis using the broader recommendations of the 2011 revision.Results3537 patients had a diagnosis of COPD. Spirometry was recorded for 2458(69%). 709(29%) did not meet GOLD criteria. 1749(49%) with confirmed COPD were analysed: 8.6% under-treated, 38% over-treated. Over-prescription of ICS in GOLD stage I or II (n=403, 38%) and in GOLD III or IV without exacerbations (n=231, 33.6%) was common. An estimated 12 cases (95%CI 7-19) annually of serious pneumonia were likely among 897 inappropriately treated. 535 cases of overtreatment involved LABA+ICS with a mean per patient cost of £553.56/year (€650.03). Using the broader indications for ICS in the 2011 revised GOLD guideline 25% were still classified as over-treated. The estimated risk of 15 cases of pneumonia (95%CI 8-22) in 1074 patients currently receiving ICS would rise by 20% to 18 (95%CI 9.8-26.7) in 1305 patients prescribed ICS if all with GOLD grade 3 and 4 received LABA+ICS.ConclusionOver-prescription of ICS in confirmed COPD was widespread with considerable potential for harm. In COPD where treatment is often escalated in the hope of easing the burden of disease clinicians should consider both the risks and benefits of treatment and the costs where the benefits are unproven.

AB - IntroductionCombined inhaled long-acting beta-agonists and corticosteroids (LABA+ICS) are costly. They are recommended in severe or very severe chronic obstructive pulmonary disease (COPD). They should not be prescribed in mild or moderate disease. In COPD ICS are associated with side-effects including risk of pneumonia. We quantified appropriateness of prescribing and examined the risks and costs associated with overuse.MethodsData were extracted from the electronic and paper records of 41 London general practices (population 310,775) including spirometry, medications and exacerbations. We classified severity, assessed appropriateness of prescribing using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for 2009, and performed a sensitivity analysis using the broader recommendations of the 2011 revision.Results3537 patients had a diagnosis of COPD. Spirometry was recorded for 2458(69%). 709(29%) did not meet GOLD criteria. 1749(49%) with confirmed COPD were analysed: 8.6% under-treated, 38% over-treated. Over-prescription of ICS in GOLD stage I or II (n=403, 38%) and in GOLD III or IV without exacerbations (n=231, 33.6%) was common. An estimated 12 cases (95%CI 7-19) annually of serious pneumonia were likely among 897 inappropriately treated. 535 cases of overtreatment involved LABA+ICS with a mean per patient cost of £553.56/year (€650.03). Using the broader indications for ICS in the 2011 revised GOLD guideline 25% were still classified as over-treated. The estimated risk of 15 cases of pneumonia (95%CI 8-22) in 1074 patients currently receiving ICS would rise by 20% to 18 (95%CI 9.8-26.7) in 1305 patients prescribed ICS if all with GOLD grade 3 and 4 received LABA+ICS.ConclusionOver-prescription of ICS in confirmed COPD was widespread with considerable potential for harm. In COPD where treatment is often escalated in the hope of easing the burden of disease clinicians should consider both the risks and benefits of treatment and the costs where the benefits are unproven.

U2 - 10.1371/journal.pone.0075221

DO - 10.1371/journal.pone.0075221

M3 - Article

C2 - 24194824

VL - 8

JO - PL o S One

JF - PL o S One

SN - 1932-6203

IS - 10

M1 - e75221

ER -

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