Abstract

Aim: To assess the appropriateness of ICS prescribing in patients with moderate to severe COPD in primary care setting in relation to blood eosinophil count (BEC) and exacerbation history

Methods: A quantitative research methodology was utilised. Data was collected across 4 different GP practices across LLR where by 6 final year pharmacy students. Patients were identified from the QOF-COPD register 2020/21, and data was extracted from the electronic medical records on SystemOne using advanced search function in “tab journal”. Severity of COPD assessed and recorded FEV1/FVC ratio, post bronchodilator FEV1, and exacerbation history. Data was analysed using IBM SPSS version 26 software. Local guidelines were utilised for assessment of appropriateness of ICS prescribing.

Results: A total of 328 patients were included in the data collection. 6% (n=20) patients suffered more than 4 exacerbations in 12 months, of which 65% (n=13) who had FEV1<50% or BEC >0.3x109/L were appropriately prescribed ICS/LABA. 37.5% (n=123) of total sample had FEV1 > 50% and BEC <0.3x109/L. 37% (n=46) were prescribed ICS inappropriately, where ICS should have been stopped. 6% (n=19) of all patients had FEV1 ≤ 50% predicted, fewer than 2 exacerbations in last 2 years, and highest eosinophil count <0.3x109/L, of which 74% (n=14) were prescribed moderate to high dose ICS which should have been stopped. Further, 8% (n=26) across all surgeries prescribed high dose ICS which should be stepped down to moderate dose ICS. Additional findings included a lack of consistency in clear documentation of diagnosis and severity of COPD which posed difficulties in assessment criteria.

Conclusion: Further work is needed in good record keeping with regards to clear diagnosis and phenotype, which impacts on the selection of ICS prescribing. Additionally, high dose ICS should be reviewed to reduce the incidence of long term complications such as pneumonia and reduced bone density.