Abstract

Oral corticosteroids (OCS) are often prescribed along with antibiotics in a “rescue pack” for patients experiencing a COPD exacerbation but their use may not always be appropriate. Recently, the Imperial College Healthcare NHS Trust (ICHT) Integrated Respiratory Service (IRT) conducted a project to identify and optimise patients who may be at increased risk for a COPD admission due to frequent use of rescue packs. The IRT collaborated with two NWL PCNs to identify patients using frequent rescue packs (≥2 course/year) and understand the reasons behind their use.

We performed searches within the primary care records (SystmOne) of each GP practice using the criteria “patient on COPD QoF register and ≥2 courses of OCS in past 12 months”. We identified a total of 173 patient’s (17.6% of QoF register). We excluded patients on long-term OCS, using OCS for non-COPD reasons, and those already under specialist respiratory care. 47 patients underwent a virtual file review and were asked to participate in the project to receive specialist care from a multidisciplinary team (respiratory consultant, nurse/physiotherapist specialist, practice pharmacist/GP).

45% were current smokers and only 4 patient’s completed Pulmonary Rehabilitation (PR) in the last 5 years. 23% were illicit drug users and/or had alcohol dependence and 66% had mental health issues. Subjectively, many patients had poor understanding of the appropriate use of rescue packs and did not understand the consequences of overuse.

In conclusion, patients who are frequent users of rescue packs may be using them inappropriately and not be aware of the potential harm. Others had potentially treatable causes for frequent exacerbations. We recommend that patients issued frequent rescue packs in primary care are identified and reviewed so they can be encouraged to engage and be educated about appropriate use and dangers of overuse, and ensure other highly valued interventions have been offered.