A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden

Figures & data

Table 1 Characteristics Of The COPD Patients Divided In The Subgroups With Respect To Benefit And Appropriateness Of ICS Therapy In COPD

		Would Benefit of ICS			Would Not Benefit Of ICS
		Appropriate Therapy With ICS (n = 159)	Possible Indication For ICS (n = 37)	pValue	Appropriate Treatment Without ICS (n = 170)	Possible Overtreatment With ICS (n = 195)	pValue
Sex	Female	102 (64%)	21 (57%)	0.452	86 (51%)	118 (61%)	0.058
Age, years		68 (8)	67 (9)	0.370	69 (7)	69 (8)	0.370
BMI	< 22	17 (11%)	4 (11%)	0.382	24 (14%)	37 (19%)	0.264
	22 – 30	93 (59%)	26 (70%)		106 (62%)	121 (63%)
	> 30	48 (30%)	7 (19%)		40 (24%)	35 (18%)
Smoking	Never	2 (1%)	0 (0%)	0.553	2 (1%)	5 (3%)	0.006
	Former	114 (72%)	24 (65%)		105 (62%)	146 (75%)
	Current	42 (27%)	13 (35%)		63 (37%)	44 (23%)
FEV1% predicted		53 (17)	66 (16)	<0.001	64 (15)	51 (18)	<0.001
Severity of airflow limitation	FEV1 ≥ 80%	11 (7%)	6 (16%)	0.030	24 (14%)	15 (8%)	<0.001
	50% ≤ FEV1 < 80%	80 (50%)	24 (65%)		120 (71%)	84 (43%)
	30% ≤ FEV1 < 50%	54 (34%)	6 (16%)		23 (14%)	70 (36%)
	FEV1 < 30%	14 (9%)	1 (3%)		3 (2%)	26 (13%)
CAT	< 10	52 (33%)	18 (49%)	0.086	85 (50%)	60 (31%)	<0.001
	≥ 10	107 (67%)	19 (51%)		85 (50%)	135 (69%)
mMRC	< 2	78 (49%)	22 (60%)	0.278	121 (71%)	93 (48%)	<0.001
	≥ 2	81 (51%)	15 (40%)		49 (29%)	102 (52%)
Level of care	Primary	126 (79%)	35 (95%)	0.031	168 (99%)	150 (77%)	<0.001
	Secondary	33 (21%)	2 (5%)		2 (1%)	45 (23%)
Study centre	Uppsala	41 (26%)	9 (24%)	0.550	39 (23%)	58 (30%)	<0.001
	Gävleborg	76 (48%)	15 (41%)		48 (28%)	81 (42%)
	Dalarna	42 (26%)	13 (35%)		83 (49%)	56 (29%)

Notes: Categorical values given as n (%), continuous variables given as mean (SD).

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; FEV, forced expiratory volume; ICS, inhaled corticosteroid; mMRC, modified Medical Research Council; SD, standard deviation.

Figure 1 (A) COPD treatment as percentages of patients in the different COPD treatment groups for all study patients (n = 561). (B) Percentages of patients by severity of airflow limitation and by COPD treatment for all study patients (n = 561).

Abbreviations: FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroid; LABA, long-acting beta-2-agonist; LAMA, long-acting muscarinic antagonist.

Figure 2 Flow chart of categorizing the COPD patients (n = 561) into subgroups based on comorbidity of asthma, history of exacerbations, B-Eos count and treatment of ICS.

Abbreviations: Frequent exa, frequent exacerbations, ≥2 exacerbations treated in primary care or at emergency room and/or ≥1 hospital admissions during the previous year due to worsening in COPD; B-Eos, blood eosinophil count as cells/µL; ICS, inhaled corticosteroid.

Figure 3 Adjusted odds ratios with 95% CIs for variables associated with COPD treatment including ICS in combination with LABA and/or LAMA in a multivariable logistic regression analysis, adjusted for sex, study centre and smoking.

Abbreviations: CAT, COPD Assessment Test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; Freq exa, frequent exacerbations, ≥2 exacerbations treated in primary care or at emergency room and/or ≥1 hospital admissions during the previous year due to worsening in COPD; ICS, inhaled corticosteroid; LABA, long-acting beta-2-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council; OR, odds ratio; ref, reference.

Data Availability

Data cannot be made freely available as they are subject to secrecy in accordance with the Swedish Public Access to Information and Secrecy Act, but can be made available to researchers upon request (subject to a review of secrecy).