Cumulative dispensing of oral corticosteroids over 12 months in COPD

Use of oral corticosteroids (OCS) is an effective treatment recommended for COPD exacerbations however, high cumulative lifetime doses (≥1000mg prednisolone-equivalent) are associated with serious adverse health effects. The importance of this issue is well defined in asthma, but is less well understood in COPD. The aim of this study was to examine cumulative dispensing of OCS in people with COPD in the 12 months following pulmonary rehabilitation. This retrospective study used administrative data for people with a confirmed COPD diagnosis. In 232 participants (126 females, age mean 68 (SD 9) years, FEV1 53 (22) %predicted), 52% (n=120) were not dispensed OCS. 26% (n=62) of participants were dispensed ≥1000mg; 11% (n=7) were dispensed ≥1000mg within the first month of the 12-month study period and 63% (n=39) were dispensed ≥1000mg within the first 6 months. For participants dispensed ≥1000mg, 43% (n=26) were dispensed adequate inhaled corticosteroids (dose sufficient for ≥300 days) for ongoing management. For participants who were dispensed OCS more than once, 88% (n=56/64) were dispensed OCS again within 90 days. 44% of OCS scripts (180/405) were dispensed within 0-1 day of prescription and were for a higher dose (median 750 IQR 300-750mg) compared to scripts filled ≥2 days after prescription (median 300 IQR 300-750mg; p=0.001). Of participants with relevant comorbidities, 36% of participants with diabetes (n=14/25) and 40% of participants with osteoporosis (n=19/35) were dispensed ≥1000mg. People with COPD who have undertaken pulmonary rehabilitation were dispensed potentially unsafe cumulative lifetime doses of OCS over 12 months. Future work is require to explore the clinical importance of this issue in COPD.