Inappropriate Overuse of Inhaled Corticosteroids for COPD Patients: Impact on Health Costs and Health Status

The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged C40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, selfreported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p\0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: €1,590 (SD = 1,834) vs. €1,157 (SD = 1,536) (p\0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36–5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02–1.97)], depression [OR: 1.47 (95% CI: 1.05–2.05)], any allergy [OR 1.69 (95% CI: 1.13–2.54)], and physical health status [OR 0.97 (95% CI: 0.96–0.98)]. Lack of adherence to the recommended criteria for using inhaled corticosteroids therapy in the management of COPD patients was associated with lower self-reported health status and higher costs. Factors statistically associated with inappropriate use of corticosteroids were educational attainment, a history of heart disease, depression, any allergy, and physical health status.