ATS 2019—Inhaled corticosteroid overuse and misuse common in COPD


  • Tara Haelle
  • Conference Reports
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Takeaway

  • Nearly a third of patients with COPD with no exacerbation history overuse inhaled corticosteroids (ICS), especially those with more primary care visits or greater airflow obstruction. 

Why this matters

  • ICS treatment guidelines changed from 2011 to 2017, potentially creating uncertainty in indications, and ICS overtreatment increases pneumonia risk with marginal benefit.

Study design

  • Cross-sectional study of 25,814 veteran patients with COPD who filled ≥2 ICS prescriptions without appropriate indication within 1 year of 9/16/2016.
    • Patients had recent inpatient/outpatient COPD encounter and spirometry.
    • Excluded patients with asthma or who had ≥1 inpatient or ≥2 outpatient exacerbations in past year.
  • Involved 15 VA medical centers and 100 primary care clinics across US.
  • Funding: National Institutes of Health and Veterans’ Affairs.

Key results

  • 29.5% patients with airflow obstruction (AFO) (n=16,452) overusing ICS; 70.5% not using ICS.
    • Greater risk of ICS overuse with each primary care visit in past year (prevalence ratio [PR], 1.06; 95% CI, 1.04-1.09) and per 10-point decrease in FEV1 (PR, 1.20; 95% CI, 1.16-1.23) after adjustment for demographics, inhaled medications, comorbidities, and driving distance from clinic.
  • 14.2% patients without AFO (n=9362) misusing ICS.
    • Greater risk of ICS misuse associated with obesity, drug abuse, and higher FEV1.