Grant: Travel Awards - Institute Community Support

Rationale Chronic obstructive lung disease (COPD) is a common and manageable respiratory disease responsible for significant mortality and morbidity worldwide. Evidence suggests COPD pharmacotherapy reduces exacerbations, decreases hospitalizations and improves patient's functional status. However, while great strides have been made towards pharmacotherapy options, it remains unclear if the proportion of patients receiving recommended maintenance pharmacotherapies has improved. Methods We conducted a large, population-based retrospective cohort study using health administrative data from Ontario, the largest province in Canada. Patients aged 66 years or older with physician-diagnosed COPD from 2004-2015 were stratified by severity using the 2018 GOLD COPD criteria. Crude and age-sex direct standardized rates of patients receiving COPD medications appropriate to each severity of COPD were calculated in accordance with GOLD recommendations. Confidence limits were calculated using a gamma distribution function. Results A total of 144,035 people were identified with physician diagnosed COPD. A stable proportion of people with COPD received appropriate short-acting bronchodilators over time with standardized rates ranging from 44% to 49%. Proportions of people with both low severity (Group B) COPD who received appropriate pharmacotherapy increased to 51.3%, in 2015, an absolute increase of 21.5% since 2004. Similarly, the proportion of people with high-risk COPD who received appropriate long-term maintenance therapy increased to more than 85% of individuals, representing an absolute increase of 20.7%. Conclusion Despite significant improvements in the use of long-term maintenance pharmacotherapy, recommended COPD therapy continues to be underused, especially in patients with Group B COPD. Future strategies should be aimed at optimizing prescription practices with the goal of improving patient's health and reducing the financial burden toward health care systems.