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Triple inhaled ther...
Triple inhaled therapy in COPD patients : determinants of prescription in primary care
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- Vetrano, Davide L. (author)
- Karolinska Institutet,Stockholms universitet,Centrum för forskning om äldre och åldrande (ARC), (tills m KI),Catholic University of Rome, Italy; IRCCS Fondazione Policlinico “A. Gemelli”, Italy; University of Brescia, Italy
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Zucchelli, Alberto (author)
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Bianchini, Elisa (author)
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Cricelli, Claudio (author)
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Piraino, Alessio (author)
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Zibellini, Marco (author)
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Ricci, Alberto (author)
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Onder, Graziano (author)
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Lapi, Francesco (author)
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(creator_code:org_t)
- Elsevier BV, 2019
- 2019
- English.
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In: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 154, s. 12-17
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http://www.resmedjou...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Objective: To assess the incidence and determinants of the triple inhaled therapy in chronic obstructive pulmonary disease (COPD) primary care patients.Methods: Data derived from the Health Search Database (HSD) gathering information on 700 Italian general practitioners. A cohort of COPD patients, prescribed for the first time with inhaled treatments, was followed-up between January 2002 and December 2014. The outcome was the first incident prescription of a triple inhaled therapy, namely the combination of inhaled corticosteroids (ICS), long-acting beta agonists (LABA), and long-acting muscarinic antagonists (LAMA). Cox regressions were used to test the association (hazard ratios, HR) between candidate determinants and the outcome.Results: Out of 17589 patients (mean age 71.1 +/- 11.3 years; 37.4% females), 3693 (21%) were prescribed with a triple inhaled therapy during follow-up. Older age (HR=1.79 to 2.61), current and former smoking habit (HR=1.72 and 1.66), higher GOLD stage (HR=1.45 to 2.79), the number of moderate and severe COPD exacerbations (HR=1.10 to 2.63), and heart failure (HR=1.17) resulted statistically significantly associated with an increased incident prescription of the triple inhaled therapy. Female sex (HR=0.80) and some co-morbidities (HR=0.21 to 0.87) resulted negatively associated with the outcome. Furthermore, patients initially treated with LAMA (HR=1.5) and LABA/ICS (HR=1.23) were more likely to escalate to the triple therapy, than those on LABA. Conversely, patients initially treated with ICS presented a negative hazard (HR=0.72).Conclusions: The knowledge of demographic and clinical determinants of the escalation to the triple inhaled therapy in real-world COPD patients may help clinicians to better personalize respiratory pharmacological treatments of their patients, and inform international societies that issue clinical guidelines.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
Keyword
- COPD
- Triple inhaled therapy
- Primary care
- Clinical guidelines
Publication and Content Type
- ref (subject category)
- art (subject category)
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