Identifying pharmacy medicine-dispensing patterns associated with high risk of asthma and COPD exacerbation: an...

To determine whether patterns of asthma and/or chronic obstructive pulmonary disease (COPD) medicine dispensed in pharmacy dispense records (PDRs) associated with high risk of asthma and COPD exacerbation can be identified in long-term PDRs.

Retrospective cohort study.

NostraData between 2011 and 2019.

Deidentified PDRs containing respiratory medicines, with a minimum of three dispensing events across at least 5 years.

The primary outcome measures were to describe the frequency, duration and dosage of medicines such as short-acting beta-agonist (SABA), oral corticosteroids (OCS) and inhaled corticosteroids (ICS), dispensed within PDRs containing respiratory medicines.

Of 26 055 926 PDRs explored, 14.7% were eligible for inclusion (n=3 837 950) and represented people with a median age of 48 years who visited an average of five different pharmacies over a range of 5-8 years. The most common medicine dispensed was SABA (72.7%), and 35.2% were dispensed ≥3 in a year. Almost half the PDRs dispensed with OCS (49.2%) were dispensed ≥1 g cumulatively. Asthma and asthma/COPD PDRs were most commonly dispensed Global Initiative for Asthma (GINA) Step 4 medications (36%), and only 7.5% of PDRs demonstrated ≥60% adherence to preventer/controller inhalers.

Patterns of medication dispensing associated with high risk of asthma and COPD exacerbation, such as the overuse of SABA and OCS and inadequate adherence to preventer/controller inhalers, can be identified in long-term PDRs. This real-time information in PDRs should be further researched to support identification of people at risk of exacerbation in primary care, to optimise management in primary care and deliver targeted intervention.