Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016

Figures & data

Figure 1 Total number of inhalers prescribed for COPD patients since 2000, and total number of COPD patients within the database.

Abbreviations: CPRD, Clinical Practice Research Database; ICS, inhaled corticosteroids; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting beta-agonist.

Figure 2 Inhaler prescriptions for patients prescribed their first COPD maintenance inhalers (N=169,511), and the temporal relationship to key moments of COPD management in UK history.

Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist.

Figure 3 Inhaler prescriptions for all COPD patients during each year (N=187,588).

Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting beta-agonist.

Table 1 Characteristics of patients in 2016 by their inhaler treatment

	ICS	LABA	LAMA-ICS	LAMA	LABA-LAMA	LABA-ICS	Triple	Total
Males	1,161	453	411	3,693	1,606	5,901	12,049	25,274
	44.2%	49.7%	47.7%	53.0%	53.6%	48.4%	50.5%	50.1%
Age (median, IQR, years)	69.5 (61-79)	70.5 (64-79)	70.5 (64-79)	70.5 (63-78)	69.5 (63-78)	70.5 (62-79)	70.5 (64-78)	70.5 (63-78)
BMI (median, IQR, kg/m^2)	27.3 (24-31)	27.2 (24-31)	27 (24-31)	26.7 (23-31)	27.1 (24-31)	27.4 (24-32)	26.8 (23-31)	27 (23-31)
GOLD stage
1	877	273	1,958	3,366	748	254	4,998	12,474
	46.0%	35.0%	33.8%	34.1%	30.6%	35.0%	23.8%	29.4%
2	827	414	2,956	4,666	1,222	349	8,914	19,348
	43.4%	53.0%	51.0%	47.3%	49.9%	48.1%	42.5%	45.5%
3	176	83	767	1,534	416	110	5,530	8,616
	9.2%	10.6%	13.2%	15.6%	17.0%	15.2%	26.4%	20.3%
4	26	11	112	292	61	12	1,526	2,040
	1.4%	1.4%	1.9%	3.0%	2.5%	1.7%	7.3%	4.8%
mMRC dyspnea
0	694	132	140	1,062	196	2,057	1,504	5,785
	32.6%	15.6%	17.5%	16.6%	7.0%	19.0%	6.5%	11.5%
1	909	451	353	3,007	1,143	4,577	7,002	17,442
	42.7%	53.4%	44.0%	46.9%	40.7%	42.3%	30.4%	34.6%
2	387	179	207	1,637	914	2,618	7,671	13,613
	18.2%	21.2%	25.8%	25.5%	32.6%	24.2%	33.3%	27.0%
3	112	72	78	596	493	1,252	5,467	8,070
	5.3%	8.5%	9.7%	9.3%	17.6%	11.6%	23.7%	16.0%
4	26	11	24	108	60	327	1,396	1,952
	1.2%	1.3%	3.0%	1.7%	2.1%	3.0%	6.1%	3.9%
Exacerbation frequency
None	2,365	863	773	6,585	2,846	10,526	20,295	44,253
	90.1%	94.7%	89.7%	94.5%	95.0%	86.3%	85.0%	87.7%
1	179	33	54	274	106	961	1,596	3,203
	6.8%	3.6%	6.3%	3.9%	3.5%	7.9%	6.7%	6.4%
>1	81	15	35	106	45	716	1,983	2,981
	3.1%	1.7%	4.1%	1.5%	1.5%	5.9%	8.3%	5.9%
Severe exacerbation
≥1	9	3	14	74	23	167	666	956
	0.3%	0.3%	1.6%	1.1%	0.8%	1.4%	2.8%	1.9%
Year diagnosed
2015-2016	482	236	158	1,975	858	1,960	2,359	8,028
	18.4%	25.9%	18.3%	28.4%	28.6%	16.1%	9.9%	15.9%
2010-2014	1,117	360	338	2,975	1,231	4,625	8,244	18,890
	42.6%	39.5%	39.2%	42.7%	41.1%	37.9%	34.5%	37.5%
≤2009	1,026	315	366	2,015	908	5,618	13,271	23,519
	39 1%	34 6%	42 5%	28.9%	30 3%	46 0%	55 6%	46 6%
Asthma
Yes	1,365	123	313	710	312	5,668	7,058	15,549
	52.0%	13.5%	36.3%	10.2%	10.4%	46.5%	29.6%	30.8%
Anxiety
Yes	770	266	263	1,988	866	3,575	7,502	15,230
	29.3%	29.2%	30.5%	28.5%	28.9%	29.3%	31.4%	30.2%
Depression
Yes	895	303	288	2,331	1,065	4,211	8,732	17,825
	34.1%	33.3%	33.4%	33.5%	35.5%	34.5%	36.6%	35.3%
Symptoms
Yes	871	314	342	2,368	1,296	4,325	10,300	19,816
	34.1%	33.3%	33.4%	33.5%	35.5%	34.5%	36.6%	39.3%
MRC ≥2 or exacerbation > 1 or severe exacerbation ≥ 1
Yes	585	271	2,434	4,618	1,495	338	15,268	25,009
	22.3%	29.8%	35.0%	37.8%	49.9%	39.2%	64.0%	49.6%

Notes: There were 55,529 patients in 2016 who had a full year of eligible linked CPRD-HES data; 50,437 patients are shown here as those prescribed SABA only are not included in this table. Exacerbation frequency and severity applied to exacerbations during 2016; frequency refers to the number of exacerbations treated in that year and a severe exacerbation was treated in hospital. Statistical tests were significant for all variables across each class (P<0.001). The color shading from green to red represents the comparative percentage value when compared with the rest of the row; red = highest percentage, green = lowest percentage.

Abbreviations: BMI, body mass index; CPRD, Clinical Practice Research Database; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HES, Hospital Episode Statistics; ICS, inhaled corticosteroids; IQR, interquartile range; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council; SABA, short-acting beta-agonist.