Journal Information
Vol. 43. Issue 2.
Pages 73-80 (February 2007)
Share
Share
Download PDF
More article options
Vol. 43. Issue 2.
Pages 73-80 (February 2007)
Original Articles
Full text access
Drug Prescription for Chronic Obstructive Pulmonary Disease and Asthma by Primary Care Physicians in the Spanish Autonomous Community of Madrid, 1996-2002
Visits
4433
Cristina Rodríguez Escolara,
Corresponding author
crodrigueze.gapm05@salud.madiid.org

Correspondence: Dra. C. Rodríguez Escolar. Servicio de Farmacia. Gerencia de Atencion Primaria Área 5. Melchor Fernández Almagro. 1. 28029 Madrid. Espańa
, Luz Fidalgo Garcíab
a Servicio de Farmacia, Gerencia de Atención Primaria Área 5, Servicio Madrileño de Salud, Madrid, Spain
b Servicio de Farmacia, Gerencia de Atención Primaria Área 8, Servicio Madrileño de Salud, Madrid, Spain
This item has received
Article information
Objective

To identify trends in the drug prescription used to treat chronic obstructive pulmonary disease (COPD) and asthma at the primary care level in Madrid between 1996 and 2002, and to assess the repercussion of new treatments.

Patients and Methods

We analyzed information on primary care general practitioners' and pediatricians' drug prescription from the R03 group (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical Classification System. Drug consumption was measured by recording the number of packages charged to the Spanish National Health Service and dispensed in pharmacies in the Spanish autonomous community of Madrid between 1999 and 2002. Consumption was expressed as defined daily dose per 1000 inhabitants per day.

Results

Drug use expressed as defined daily dose per 1000 inhabitants per day for COPD and asthma in Madrid increased by 18.48% between 1996 and 2002. The use of inhalants increased by 33.5% over the same period. The most marked differences were the increase in the number of patients treated with selective β2 adrenergic agonists, anticholinergics, and combinations of fixed doses of long acting β2 agonists with corticosteroids. The most-used drugs in 2002 were selective β2 adrenergic agonist inhalants (37.7%), anticholinergics (22.5%), corticosteroids (19.5%), and combinations of fixed doses of long acting β2 adrenergic agonists with corticosteroids (10.5%), and xanthines (5.03%). In 2002, the prescription of 5 new treatments amounted to 15.76% of total use of COPD and asthma drugs (R03 group).

Conclusions

Drug use for obstructive diseases of the airways showed a sharp increase between 1996 and 2002. Changes in patterns of use were observed, new treatments being quickly adopted, modifying the profile of drug prescription for the management of COPD and asthma.

Key words:
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Drug use
Defined daily dose
Primary care
Objetivo

Conocer la tendencia en la utilización de los medicamentos para el tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC) y el asma en atención primaria de Madrid entre 1996 y 2002, y evaluar la repercusión de las novedades terapéuticas.

Pacientes y Métodos

Se ha analizado la información sobre el consumo, en número de envases, de los medicamentos incluidos en el grupo R03 (“Medicamentos para enfermedades obstructivas de las vías aéreas”) que prescribieron médicos de familia y pediatras de atención primaria, y que, facturados con cargo al Sistema Nacional de Salud, se dispensaron en las oficinas de farmacia de la Comunidad de Madrid en el período 1996-2002. El consumo se expresa en dosis diarias definidas por 1.000 habitantes y día.

Resultados

El consumo de medicamentos, expresado en dosis diarias definidas por 1.000 habitantes y día, para la EPOC y el asma en Madrid aumentó un 18,48% entre 1996 y 2002. La utilización de la vía inhalada creció un 33,5% en dicho período. Las variaciones más destacables se centraron en el incremento del número de pacientes tratados con agonistas adrenérgicos β2 selectivos, anticolinérgicos y asociaciones a dosis fijas de agonistas β2 de acción larga con glucocorticoides. Los grupos más consumidos en 2002 fueron los agonistas adrenérgicos β2 selectivos por vía inhalada (37,7%), anticolinérgicos (22,5%), glucocorticoides (19,5%), asociaciones a dosis fijas de agonistas adrenérgicos β2 de acción larga junto con glucocorticoides (10,5%) y xantinas (5,03%). En 2002 la prescripción de 5 novedades terapéuticas generó el 15,76% del total del consumo de los fármacos utilizados en la EPOC y el asma (grupo R03).

Conclusiones

El consumo de medicamentos para enfermedades obstructivas de las vías aéreas muestra un notable crecimiento entre 1996 y 2002. Se observan cambios en los patrones de utilización, incorporándose a gran velocidad nuevas opciones terapéuticas que modifican el perfil de prescripción de los medicamentos utilizados en el manejo de la EPOC y el asma.

Palabras clave:
Enfermedad pulmonar obstructiva crónica (EPOC)
Asma
Utilización de medicamentos
Dosis diaria definida
Atención primaria
Full text is only aviable in PDF
REFERENCES
[1]
CJ Murria, AD Iopez.
Alternative projections of mortality and disability by cause 1990-2020. Global Burden of Disease Study.
Lancet, 349 (1997), pp. 1498-1504
[2]
BR Celli, W MacNee, committee members.
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.
Eur Respir J, 23 (2004), pp. 932-946
[3]
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: NHLBI/WHO Workshop (National Heart, Lung, and Blood Institute: Claude Lenfant, MD. World Health Organization: Nikolai Khaltaev), UPDATE 2004 [cited 2005 Apr 7]. Available from: http://www.goldcopd.com/
[4]
Global Strategy for Asthma.
Management and Prevention. NHLBI/WHO Workshop Report, National Institute of Health, (2002),
[5]
V Sobradillo, M Miravitlles, R Gabriel, CA Jimenez, C Villasante, JF Masa, et al.
Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentric epidemiological study.
Chest, 118 (2000), pp. 981-989
[6]
V Sobradillo, M Miravitlles, CA Jimenez, R Gabriel, JL Viejo, JF Masa, et al.
Estudio IBERPOC en Espana: prevalencia de sfntomas respiratorios y de limitation cronica al flujo aereo.
Arch Bronconeumol, 35 (1999), pp. 159-166
[7]
M Miravitlles, C Murio, T Guerrero, R Gisbert, on behalf of the DAFNE study group.
Costs of chronic bronchitis and COPD. A one year follow-up study.
Chest, 123 (2003), pp. 784-791
[8]
Informe del Estado de Salud de la Poblacion de Madrid, Comunidad de Madrid, (2003),
[9]
J Escarrabill.
Costes sanitarios de la enfermedad pulmonar obstructiva cronica (EPOC).
Arch Bronconeumol, 39 (2003), pp. 435-436
[10]
JF Masa, V Sobradillo, C Villasante, CA Jimenez-Ruiz, L Femandez-Fau, JL Viejo, et al.
Costes de la EPOC en Espana. Estimation a partir de un estudio epidemiologico poblacional.
Arch Bronconeumol, 40 (2004), pp. 72-79
[11]
J de Miguel.
Farmacoeconomia en el asma y en la EPOC.
Arch Bronconeumol, 41 (2005), pp. 239-241
[12]
Grupo Espanol para el Manejo del Asma (GEMA).
Gufa Espanola para el Manejo del Asma, GEMA, (2003),
[13]
L Garcia-Marcos, A Blanco Quiros, G Hernandez Garcia, C Gonzalez Dfas, I Carvajal Urena, A Arrendo Pena, et al.
Stabilization of asthma prevalence among adolescents and increase among schoolchildren (ISAAC phase I and III) in Spain.
Allergy, 59 (2004), pp. 1302-1307
[14]
A Nieto, E Alvarez-Cuesta, M Boquete, A Mazon, F de la Torre.
The cost of asthma treatment in Spain and rationalizing the expense.
J Investig Allergol Clin Immunol, 11 (2001), pp. 139-148
[15]
J Serra-Batlles, V Plaza, E Morejon, A Cornelia, et al.
Cost of asthma according to degree of severity.
Eur Respir, 12 (1998), pp. 1322-1326
[16]
M Siles, L Avila, V Gomez, B Crespo.
Sistema de codification de principles activos y dosis diarias definidas del Insalud, 2nd ed., Ministerio de Sanidad y Consumo. Institute National de la Salud. Subdireccion General de Coordination Administrativa, (2002),
[17]
Farmacia.
Atencion Primaria en el INSALUD: 17 anos de ex-periencia, pp. 102-104
[18]
JG Garcia del Pozo, R Mateos Campos, V Garcia del Pozo, M Benet Rodriguez, A Carvajal, et al.
Trends in the use of antiasthmatics in Spain (1989-1998).
Clin Drug Invest, 22 (2002), pp. 709-713
[19]
Chronic obstructive pulmonary disease: national clinical guide line on management of chronic obstructive pulmonary disease in adults in primary and secondary care.
[20]
PRICE. Programa Integral de Control de la EPOC en Neumologia y Atencion Primaria. Madrid: NEUMOMADRID. SMMFYC. SE-MERGEN [cited 2005 March 20]. Available from: http://www.neumomadrid.org/price.html/
[21]
Scottish Intercollegiate Guidelines Network.
British Thoracic Society. British guideline on the management of asthma.
[22]
RM Busquets Monge, E Sanchez Sanchez, L Pardos Rocamora, JR Villa Asensi, J Sanchez Jimenez, M Ibero Iborra, et al.
Con-senso de asma, neumologia y alergia pediatrica (draft).
Allergol et Immunopathol, 32 (2004), pp. 1004-1018
[23]
AC Boyter, DT Steinke.
Changes in prescribing of inhaled corti-costeroids (1999-2002) in Scotland.
Pharmacoepidemiol Drug Saf, 14 (2005), pp. 203-209
[24]
H Majeed, J Ferguson, J Field.
Prescribing of beta-2 agonists and inhaled steroids in England: trends between 1992 and 1998, an association with material deprivation, chronic illness and asthma mortality rates.
J Public Health Med, 21 (1999), pp. 395-400
[25]
Fluticasone+salmeterol.
La Revue Prescribe, 21 (2001), pp. 664-666
[26]
L Nannini, CJ Gates, TJ Iasserson, P Poole.
Combined corticosteroid and longacting beta-agonist in one inhaler for chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews, (2004),
[27]
I Mayers, R Damant.
Role of combination inhaled corticosteroids and long acting beta agonists in the treatment of adult asthma. Issues in Emerging Health Technology [issue 68], Canadian Coordinating Office for Health Technology Assessment, (2005),
[28]
The Newcastle Regional Drug and Therapeutics Centre (RDTC).
Steroid/long-acting beta2 agonist combination inhalers in asthma and COPD, Regional Drug and Therapeutics Centre (RDTC), (2005),
[29]
J de Miguel Dfez, JL Izquierdo Alonso, J Molina Paria, JM Bellon Cano, JM Rodriguez Gonzalez-Moro, P Iucas Ramos.
Facto-res determinantes de la prescription farmacologica en los pacien-tes con EPOC estable. Resultados de un estudio multicentrico es-panol (IDENTEPOC).
Arch Broconeumol, 41 (2005), pp. 63-70
[30]
Institute de Salud Piiblica.
Gufa de apoyo para el abordaje del ta-baquismo, Institute de Salud Piiblica. Direction General de Salud Piiblica. Consejeria de Sanidad y Consume, (2004),
[31]
N Adams, JM Bestall, TJ Iasserson, PW Jones.
Fluticasona inha-lada versus beclometasona o budesonida inhalados para el asma cronica en adultos y ninos (translated Cochrane review). La Bi-blioteca Cochrane Plus. 2005(4), Update Software Ltd., (2005),
[32]
D Ng, F di Salvio, G Hicks.
Agentes antileucotrienos comparados con corticosteroides inhalados para el tratamiento del asma recu-rrente y/o cronica en adultos y ninos (translated Cochrane review).
[33]
FSF Ram, CJ Gates, FM Ducharme.
Agonistas beta2 de action prolongada versus antileucotrienos como tratamiento adicional a los corticosteroides inhalados para el asma cronica (translated Cochrane review).
[34]
Institute Nacional de Estadistica [cited 2005 March 20].
Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?