P35 Inhaled corticosteroids and pneumonia in COPD at primary care level. (December 2018)

• Record Type: Journal Article
• Authors: Ibrahim, J; Ali, A; Zeb, M; Crawford, E; Makan, A; Srinivasan, K; Moudgil, H; Ahmad, N
• Is Part Of: Thorax. Volume 73(2018)Supplement 4
• Page Start: A114
• Page End: A115
• Publication Date: 2018-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2018-212555.193
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Association between inhaled corticosteroids and pneumonia in COPD population is well known. 1 And the risk of pneumonia is greatest with the use of high dose inhaled corticosteroids (HD-ICS). 2 Hence, further work to reduce the prescription of HD-ICS should be informed by local practices. Aim: We aimed to assess the incidence of pneumonia in COPD patients based at primary practices in our region according to their HD-ICS prescriptions. And thereby develop methods to safely wean off HD-ICS in this population. Methods: Data was obtained on all hospital admissions for pneumonia between April-September 2017 with a secondary diagnosis code of J44 indicating COPD, from the head of information at our clinical commissioning group. We divided this data at a general practice level. We also obtained data on prescription of HD-ICS at each of the general practices till September 2017 from openprescribing.net. Statistical results were obtained from MS Excel and Vassar Stats. Results: There are 14 general practices in the region. There were 123 pneumonia admissions to hospital with a secondary diagnosis of COPD. This included 50% males (n=62) with a mean age (SD) of 75 (9.7) years. There were 5 practices with >10 pneumonia admissions during this period and when compared with those with <10 pneumonia admissions, the median (IQR) COPD population was 107 patients (103–126) v 47 patients (32–69) [p<0.05] with a median (IQR) use of HD-ICS prescriptions 239 (170–290) v 108 (86–172) [p<0.05]. Conclusion: Our data show an association between HD-ICS prescriptions and pneumonia in COPD population at a primary care level in our region. Having looked at the data including GP practices with higher prescriptions of HD-ICS, we have developed an algorithm (figure 1) to wean patients off HD-ICS while at the same time promoting awareness through local interest group meetings. References: Calverley PM, et al. N Engl J Med2007;356:775–89. Suissa S, Patenaude V, Lapi F, et al. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax2013;68:1029–36.