Lung function, symptoms and prescription of inhaled steroids and long acting β2agonists in patients managed by an integrated COPD team

Background: It has been noted that patients with COPD may be inappropriately prescribed long acting β 2 agonist/inhaled corticosteroid combinations (ICS/LABA). Aims: The GOLD guideline recommends that patients with an FEV 1 of Methods: The exacerbation history, CAT score, spirometry and medication of patients referred to an integrated COPD team were recorded and analysed. Results: Thirty one patients with COPD on ICS/LABA combinations were referred to the team. The mean (range) age was 69 (46-92) years. There were 19 males. The mean FEV 1 % predicted was 43 (19 – 112%). The mean (range) CAT score was 29 (18-40). Twenty two patients had an FEV 1 1 ≥ 50%, 5 had only one exacerbation in the last year, but 2 of them had Asthma-COPD overlap syndrome. Therefore, 3 of 31 (10%) did not fulfil the criteria for prescription of ICS/LABA. Exacerbation history was available for 29 of the patients. We found that frequent exacerbators (≥ 2/yr) had a higher CAT score (31.24) and lower FEV 1 (36.3%) than infrequent exacerbators (CAT: 26.50; FEV 1 55.7%) (ANOVA test; p = 0.03 for both). Conclusions: Lower FEV 1 and higher CAT scores are seen in those with more frequent exacerbations of COPD. 10% of patients with COPD did not fulfil the GOLD criteria for ICS/LABA combination.