Type of publication:
*Ibrahim J.; *Ali A.; *Zeb M.; *Crawford E.; *Makan A.; *Srinivasan K.; *Moudgil H.; *Ahmad N.
Thorax 2018;73(Suppl 4):A114
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 HDICS 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. (Figure Presented) .