Trends in initial pharmacological COPD treatment in primary care (2010-2021): a population-based study using the PHARMO Data Network.

Background: Pharmacological treatment is a cornerstone of chronic obstructive pulmonary disease (COPD) management, with general practitioners providing the most care. However, the lack of data on prescribing trends in initial pharmacotherapy in primary care hinders the understanding of how scientific and technical developments impact patient care and may also perpetuate suboptimal practices. Hence, this study aims to analyze trends in the initial pharmacological treatment of newly diagnosed COPD patients in Dutch primary care from 2010 to 2021.

Methods: A repeated cross-sectional study was conducted via the PHARMO GP Database. Data were extracted from the electronic health records of individuals managed by general practitioners in the Netherlands within the PHARMO Data Network. Individuals aged ≥ 40 years at diagnosis with an International Classification of Primary Care code for COPD (R95) were included. Initial pharmacological treatment was identified based on the first prescription issued within 90 days postdiagnosis. The annual proportions of individuals receiving a specific treatment among those diagnosed were calculated and directly standardized by age and sex according to the 2021 Dutch population structure. Trend analysis was performed via joinpoint regression.

Results: A total of 54,628 COPD patients were included (median [IQR] age: 65 [57-73]; 53.7% male), with 36.4% not receiving respiratory medication within 90 days of diagnosis, and 4.2% on other treatments. Trend analysis revealed that LAMA monotherapy increased from 13.4% in 2010 to 15.1% in 2015 and then declined to 11.0% by 2021. Moreover, LABA-ICS decreased from 17.6% to 8.5% between 2010 and 2018, after which it plateaued. In contrast, LABA-LAMA sharply increased, from 0.6% in 2010 to 9.6% in 2021. LABA monotherapy increased from 2.6% in 2010 to 5.7% in 2021. Triple therapy has remained constant. For reliever-only therapies, SABA increased from 8.5% in 2010 to 14.3% in 2018 and then stabilized, whereas SAMA and SABA-SAMA remained low throughout.

Conclusions: Shifts in initial pharmacological COPD treatment from 2010 to 2021 likely reflect the introduction of new inhalers and updated management strategies. However, a significant proportion of patients remain without GP prescriptions, which warrants further investigation.