Chronic Obstructive Pulmonary Disease in people aged 45 and over
| COPD single map | Consumer summary (254KB, pdf) |
The goal of this Atlas domain is to highlight regional and variation in the prevalence, admissions, and medicine use of people estimated to have Chronic Obstructive Pulmonary Disease (COPD).
People were identified as having COPD if, in the calendar year, they had:
- a hospital admission with any diagnosis of COPD, or
- any dispensing of long-acting muscarinic antagonists (LAMA) either alone or in combination with long-acting beta agonists (LABA) and inhaled corticosteroids (ICS).
To increase diagnostic certainty and reduce the contribution from asthma, only data for adults aged 45 years or over are included.
Two findings in particular warrant further investigation to determine whether they represent under-use of effective treatment.
- Firstly, about 4 in 10 of those admitted to hospital with a primary diagnosis of COPD did not regularly receive triple therapy in the following 12 months after admission. Triple therapy is recommended to minimise exacerbations and improve airway functioning. Noting that not all individuals admitted with COPD will meet the criteria for triple therapy.
- Secondly, one-third of those with COPD who received two or more courses of prednisone did not regularly receive triple therapy in the following 12 months. Repeated use of prednisone without optimal COPD management may indicate poorly controlled COPD.
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Key messages
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COPD Atlas accordion
COPD prevalence is markedly higher in some population subgroups than in others
COPD prevalence among the Primary Health Organisation (PHO) enrolled population
About 66,000 people aged 45 years and over and enrolled in a PHO were estimated to have COPD in 2023. COPD prevalence has increased over time from 2.4 percent in 2018 to 3.2 percent in 2023. Much of this increase is likely to be the result of increased uptake of medicines to treat COPD, rather than an actual increase in prevalence. COPD prevalence increased with age, from 1.5 percent in those aged 45–64 years to 6.9 percent in those aged 75 years and older.
Across all age groups, Māori had the highest estimated rate of COPD, and the Asian population had the lowest rate. On average, among those aged 65–74 years, Māori (11.8 percent) had the highest prevalence followed by Pacific peoples (5.1 percent), European/Other (4.1 percent) and Asian population (1.2 percent). In 2023, COPD prevalence among PHO enrolled population varied nearly three-fold by Health New Zealand | Te Whatu Ora district, from 2.7 percent to 7.3 percent of a district population aged 65–74 years, and more than three-fold in those aged 45–64 years (0.7‒3.0 percent).
COPD prevalence among New Zealand resident population
This indicator includes individuals who were not enrolled in a PHO. Over 2022 and 2023, on average about 900 people a year identified as having COPD were not enrolled in a PHO, this equates to about 1.5 percent of those in the COPD cohort. For this reason, we opted to use the PHO enrolled population as it is a more reliable way to assign demographics.
There are several limitations to our COPD cohort definition, including the underrepresentation of mild COPD cases who do not require hospitalisation or have not yet been prescribed LAMA medications and are controlled with short-acting medications. Additionally, the cohort does not capture individuals with Asthma-COPD Overlap (ACO) who receive LABA/ICS, and those with an eosinophilic pattern of disease. ACO is a condition where a patients experience features of both asthma and COPD. It is characterised by a combination of persistent airflow limitation and chronic symptoms, which overlap with the pathophysiological features of both asthma and COPD.
Our analyses showed that COPD prevalence increased over time. This could be a sign of improved use of medications, better reporting/diagnosis and increased disease burden, potentially linked to ageing population.
Our analyses suggest that smoking rates across districts are closely aligned with COPD rates, indicating a strong relationship between smoking prevalence and the burden of COPD in different regions. This correlation supports the well-established link between smoking and COPD, as smoking remains the primary risk factor for the development and progression of this chronic respiratory disease. Unfortunately, smoking status is not consistently or comprehensively captured in the health administrative data in New Zealand, which limits our ability to adjust COPD rates based on smoking history. For smoking rates by age, gender, ethnicity, please see https://www.health.govt.nz/statistics-research/surveys/new-zealand-health-survey and for smoking rates by district, see https://www.health.govt.nz/publications/regional-results-2017-2020-new-zealand-health-survey.
In addition to smoking, other important risk factors for COPD include exposure to second-hand smoke, occupational lung irritants, air pollution, and genetic factors such as alpha-1 antitrypsin deficiency. These factors contribute to the development and progression of COPD, but they are not well captured in administrative data. Therefore, the COPD rates reported in this analysis should be interpreted with caution.
Hospital admissions with primary diagnosis of COPD are higher in some population groups
COPD admission rate among the PHO-enrolled population
In 2023, nearly 7,400 people (~ 3.5 per 1,000 of the PHO-enrolled population aged 45 years or over) were admitted to the hospital one or more times with a primary diagnosis of COPD. This was a slight decrease from 2018, when the rate was 3.9 per 1,000 of the PHO-enrolled population.
The highest admission rate was among those aged 75 years or above (8.5 per 1,000 PHO-enrolled population), compared to those aged 45–64 years (1.6 per 1,000) and 65–74 years (4.6 per 1,000). Across all age groups, Māori had the highest admission rate, and Asian population had the lowest rate. For example, among those aged 65–74 years, Māori (14.9 per 1,000 PHO enrolled population) and Pacific peoples (7.6 per 1,000 PHO enrolled population) were more likely to get admitted to a hospital with primary diagnosis of COPD than European/Other (3.9 per 1,000 PHO enrolled population) and Asian population (1.0 per 1,000 PHO enrolled population).
These rates also varied by district, ranging four-fold from 2.8 to 11.7 per 1,000 PHO-enrolled population among people aged 65–74 years, and more than 2.5-fold among those aged 75 years or above (6.1 to 15.8 per 1,000 PHO enrolled population). Rates varied by gender, for example, among those aged 75 years or above, males (9.1 per 1,000 PHO enrolled population) had significantly higher admission rate when compared to females (7.9 per 1,000 PHO enrolled population).
COPD admission rate among people with COPD (COPD cohort)
In 2023, about 11.1 percent of the PHO-enrolled population aged 45 years or over with COPD were admitted to the hospital one or more times with a primary diagnosis of COPD. This represents a decline from 16.3 percent in 2018. Across all age groups, Pacific peoples had the highest admission rate (14.5 percent), followed by Māori (12.9 percent). One possible explanation for this decrease could be the increase in LAMA dispensing, which may have led to better management of COPD symptoms and fewer hospital admissions. The increase in LAMA dispensing would have also expanded the denominator of people with COPD, which might contribute to the observed decrease in the hospitalisation rate.
Māori and Pacific peoples had the highest rates of admission to hospital with a diagnosis of COPD. This finding was true for both measures looking into admissions to hospital with the PHO-enrolled population, and for the COPD cohort.
About 3% of people aged 45 years or over with COPD were admitted to hospital two or more times with primary diagnosis of COPD.
In 2023, about 1,800 people (approximately 0.9 per 1,000 PHO enrolled population aged 45 years or over) were admitted to the hospital two or more times with a primary diagnosis of COPD, a slight decrease from 2018 (about 1 per 1,000 PHO enrolled population). Māori had higher rates of recurrent admissions (2.4 per 1,000 PHO enrolled population) compared to other ethnic groups: Pacific peoples (1.0 per 1,000 population), European/Other (0.8 per 1,000 population), and Asians (0.1 per 1,000 population).
Nearly half of people with COPD regularly received triple therapy
Triple therapy, consisting of a long-acting muscarinic antagonist (LAMA), long-acting beta agonist (LABA), and inhaled corticosteroid (ICS), is recommended as the comprehensive approach to COPD management. This combination improves airflow, reduces inflammation, and minimises symptoms and exacerbations.
In 2023, about 48.6 percent of people with COPD regularly received triple therapy. These rates were consistent over time (2018–2023). Rates differed by gender. For example, females (51.3 percent) aged 45–64 years had significantly higher dispensing rates of triple therapy when compared to males (46.1 percent) in that age group. Ethnic differences are more pronounced in the younger cohort. For example, among those aged 45–64 years with COPD, triple therapy dispensing rates are highest among Māori (51.1 percent), followed by European/Other (48.8 percent), Pacific peoples (47.9 percent) and Asians (44.9 percent). These rates also varied by district; ranged from 41.9-56.5 percent among those aged 65–74 years with COPD.
About 60 percent of those admitted to hospital with a primary diagnosis of COPD regularly received triple therapy in the following 12 months
The 2021 NZ COPD guidelines recommend that practitioners consider escalating to triple LABA/LAMA/ICS therapy for patients who continue to experience exacerbations despite adherence to dual LAMA/LABA or ICS/LABA therapy. This approach aims to optimise symptom control, reduce exacerbations, and improve long-term outcomes for individuals with persistent or severe COPD. In 2023, about 58.6 percent those admitted to hospital regularly received triple therapy in the following 12 months after admission, this increased from 51.2 percent in 2019.
Two-thirds of those with COPD who received two or more courses of prednisone regularly received triple therapy in the following 12 months
Prednisone is commonly prescribed during acute exacerbations of COPD to reduce inflammation and improve airflow. While it is effective in managing short-term flare-ups, repeated use of prednisone, especially through multiple courses, without optimal COPD management may indicate poorly controlled COPD or frequent exacerbations. This pattern of frequent steroid use suggests that the patient's underlying condition may not be adequately managed, and further evaluation or adjustments to the treatment regimen may be necessary to better control symptoms, prevent exacerbations, and improve overall disease management.
In 2023, about two-thirds (67.8 percent) of individuals with COPD who received two or more courses of prednisone also regularly received triple therapy (LABA/LAMA/ICS) in the following 12 months. This suggests that despite the use of systemic corticosteroids to manage exacerbations, these patients continued to require escalated therapy with triple inhaler regimens to better control their symptoms and reduce the frequency of flare-ups. This underscores the need for a comprehensive approach to manage COPD in patients with frequent exacerbations, ensuring adequate control of the disease and improving long-term outcomes.
These rates are lowest among those aged 75+ years (64.6 percent) when compared to those aged 45–64 years (69.9 percent) and 65–74 years (69.2 percent). Rates varied 1.5-fold by Health New Zealand district for those aged 75 years or over ranging from 53.9 percent to 75.6 percent.
Among those aged 45 years or over, Pacific peoples and Māori have higher regular dispensing rates of SABA monotherapy without any preventer medication
Short-Acting Beta Agonists (SABA) are commonly used for acute symptom relief and recommended as an initial treatment for COPD but are not sufficient as a standalone treatment for long-term control. Using SABA excessively (as the sole treatment) without optimal COPD treatment can be harmful, leading to poor disease control and potentially more frequent exacerbations [1].
We found that regular SABA monotherapy dispensing rates have slightly decreased over time from 1.1 percent in 2018 to 0.9 percent in 2023. Those aged 75 years or over (1.0 percent) have higher rates of regular SABA monotherapy dispensing than younger age groups (0.9 percent for those aged 65–74 years and 0.8 percent for 45–64 years).
Across all age groups, Pacific peoples and Māori have higher rates of regular SABA monotherapy dispensing than other ethnic groups. For example, among those aged 65–74 years, Pacific peoples have highest rate of 1.9 percent followed by Māori (1.6 percent), European/Other (0.8 percent) and Asians (0.8 percent).
In 2023, regular SABA monotherapy dispensing rates varied more than two-fold by district, from 0.6 percent to 1.5 percent in those aged 65–74 years and 0.7-1.5 percent in those aged 75 years or above. When interpreting the indicator, it's important to keep in mind that the denominator for this indicator is PHO enrolled population that could comprise both COPD and asthma patients.
- Why do some districts have consistently lower or higher rates than the national mean?
- What barriers might exist that prevent people from accessing health care and collecting their medications?
- What are the socioeconomic and commercial determinants of health (eg, marketing of tobacco) that might contribute to the higher prevalence of COPD among some subgroups?
- How do districts with population distribution compare?
- What community programmes are available? Are they culturally tailored to Māori and Pacific populations?
- Do these rates differ by rurality? How does living rurally affect the outcome?
- At the practice level, how many practices have a mechanism to identify patients who have had a COPD admission and follow up if they have not rebooked within a specific timeframe to review their medications?
Chronic obstructive pulmonary disease (COPD) encompasses chronic bronchitis, emphysema, and chronic airflow obstruction. It is characterised by persistent respiratory symptoms and airflow limitation that is not fully reversible.
Chronic bronchitis is defined as daily sputum production for at least three months of two or more consecutive years. Emphysema is a pathological condition involving alveolar dilation and destruction. Breathlessness with exertion, chest tightness, and wheezing are the results of airway narrowing and impaired gas exchange. The loss of lung elastic tissue in emphysema may lead to airway wall collapse during expiration, resulting in dynamic hyperinflation and an increased work of breathing.
Chronic obstructive pulmonary disease (sometimes called chronic obstructive respiratory disease) is the fourth most common cause of death in Aotearoa New Zealand and the third most common cause of death in the Māori population [2]. A recent report by Health New Zealand stated that COPD is the third most common avoidable cause of death that is contributing to the life expectancy gap between Māori females and the non-Māori, non-Pacific population, and the sixth most common cause for Māori males [3] .
The Atlas domain draws on existing national data collections held by Health New Zealand, including the National Minimum Dataset, the Pharmaceutical Collection, and the Primary Health Organisation Enrolment Collection. Unlike other atlases, this atlas uses total response ethnicity grouping rather than prioritised ethnicity grouping. In this approach, individuals who identify with more than one ethnicity have all the ethnicities they identify with recorded. For example, if someone identifies as both Māori and Pacific, they will be counted in both ethnic categories. This method provides a more inclusive count of all ethnicities, recognising that individuals may belong to multiple ethnic groups.
The indicators looking at admissions to hospital for COPD include data for emergency department attendances meeting the three-hour rule for hospital admissions. This is because different districts handle emergency department attendances differently. For more information, see the methodology (606KB, pdf).
The Pharmaceutical Collection contains claim and payment information from community pharmacists for subsidised dispensing. This collection does not reflect adherence or whether the medication was taken effectively. Over-the-counter medicines are not included. Note our definition of regular medication use only includes people receiving medication for two or more quarters in a year. It should be noted that we did not take into account people who initiate medication later in the year.
There is no ideal rate of medicine use in people with COPD because it depends on clinical need. However, wide variation between districts or ethnic groups raises questions as to why the rate of medicine use varies. Please note that Pharmaceutical Collection has only dispensing information but not prescribing information. This limits our ability to fully understand prescribing patterns, adherence, or discrepancies between prescribed and dispensed medications.
Respiratory disease, including COPD, has been identified as one of the five priority focus areas by the New Zealand government in the Government Policy Statement on Health 2024-2027 [4]. This recognition reflects the growing concern over the burden of respiratory conditions on the healthcare system and the well-being of New Zealanders. To address this issue, the government has outlined specific actions and strategies aimed at improving the management of respiratory diseases, including COPD, across the country. One key aspect of the government's approach is the inclusion of an indicator measuring hospitalisations due to COPD
Te Tāhū Hauora would like to acknowledge Pharmac – Te Pātaka Whaioranga for supporting this work.
1. Janson C, Wiklund F, Telg G, Stratelis G, Sandelowsky H. High use of short-acting β2-agonists in COPD is associated with an increased risk of exacerbations and mortality. ERJ Open Res. 2023 Jun 19;9(3):00722-2022. doi: 10.1183/23120541.00722-2022
2. Asthma and Respiratory Foundation NZ. 2024. Understanding COPD. Wellington: Asthma and Respiratory Foundation NZ. URL: https://www.asthmafoundation.org.nz/stories/understanding-copd
3. Health New Zealand | Te Whatu Ora. 2024. Life Expectancy in Aotearoa New Zealand: An Analysis of Socioeconomic, Geographic, Sex and Ethnic Variation from 2001 to 2022. Wellington: Health New Zealand. URL: https://www.tewhatuora.govt.nz/publications/life-expectancy-in-aotearoa-an-analysis-of-socioeconomic-geographic-sex-and-ethnic-variation-from-2001-to-2022
4. Minister of Health. 2024. Government Policy Statement on Health 2024 – 2027. Wellington: Ministry of Health. URL: https://www.health.govt.nz/system/files/2024-06/government-policy-statement-on-health-2024-2027-v4.pdf
- Asthma and Respiratory Foundation NZ. 2024. NZ COPD guidelines. Wellington: Asthma and Respiratory Foundation NZ. URL: https://www.nzrespiratoryguidelines.co.nz/uploads/8/3/0/1/83014052/nz_copd_guidelines_web.pdf
- Health New Zealand | Te Whatu Ora. 2024. Chronic obstructive pulmonary disease (COPD). Wellington: Health New Zealand. URL:https://info.health.nz/conditions-treatments/lungs/chronic-obstructive-pulmonary-disease
- Te Tāhū Hauora | Health Quality and Safety Commission 2023. Chronic obstructive pulmonary disease (COPD) | He mate puru ia auraki (Frailty care guides 2023). Wellington: Te Tāhū Hauora. URL: https://www.hqsc.govt.nz/resources/resource-library/chronic-obstructive-pulmonary-disease-copd-he-mate-puru-ia-auraki-frailty-care-guides-2023/
- Healthify | He Puna Waiora 2024. COPD | Mate ia tuku. URL:https://healthify.nz/health-a-z/c/copd/
- Asthma and Respiratory Foundation NZ. 2024. COPD. Wellington: Asthma and Respiratory Foundation NZ. URL: https://www.asthmafoundation.org.nz/resources/topic/copd
Key findings
COPD prevalence is markedly higher in some population subgroups than in others
COPD prevalence among the Primary Health Organisation (PHO) enrolled population
About 66,000 people aged 45 years and over and enrolled in a PHO were estimated to have COPD in 2023. COPD prevalence has increased over time from 2.4 percent in 2018 to 3.2 percent in 2023. Much of this increase is likely to be the result of increased uptake of medicines to treat COPD, rather than an actual increase in prevalence. COPD prevalence increased with age, from 1.5 percent in those aged 45–64 years to 6.9 percent in those aged 75 years and older.
Across all age groups, Māori had the highest estimated rate of COPD, and the Asian population had the lowest rate. On average, among those aged 65–74 years, Māori (11.8 percent) had the highest prevalence followed by Pacific peoples (5.1 percent), European/Other (4.1 percent) and Asian population (1.2 percent). In 2023, COPD prevalence among PHO enrolled population varied nearly three-fold by Health New Zealand | Te Whatu Ora district, from 2.7 percent to 7.3 percent of a district population aged 65–74 years, and more than three-fold in those aged 45–64 years (0.7‒3.0 percent).
COPD prevalence among New Zealand resident population
This indicator includes individuals who were not enrolled in a PHO. Over 2022 and 2023, on average about 900 people a year identified as having COPD were not enrolled in a PHO, this equates to about 1.5 percent of those in the COPD cohort. For this reason, we opted to use the PHO enrolled population as it is a more reliable way to assign demographics.
There are several limitations to our COPD cohort definition, including the underrepresentation of mild COPD cases who do not require hospitalisation or have not yet been prescribed LAMA medications and are controlled with short-acting medications. Additionally, the cohort does not capture individuals with Asthma-COPD Overlap (ACO) who receive LABA/ICS, and those with an eosinophilic pattern of disease. ACO is a condition where a patients experience features of both asthma and COPD. It is characterised by a combination of persistent airflow limitation and chronic symptoms, which overlap with the pathophysiological features of both asthma and COPD.
Our analyses showed that COPD prevalence increased over time. This could be a sign of improved use of medications, better reporting/diagnosis and increased disease burden, potentially linked to ageing population.
Our analyses suggest that smoking rates across districts are closely aligned with COPD rates, indicating a strong relationship between smoking prevalence and the burden of COPD in different regions. This correlation supports the well-established link between smoking and COPD, as smoking remains the primary risk factor for the development and progression of this chronic respiratory disease. Unfortunately, smoking status is not consistently or comprehensively captured in the health administrative data in New Zealand, which limits our ability to adjust COPD rates based on smoking history. For smoking rates by age, gender, ethnicity, please see https://www.health.govt.nz/statistics-research/surveys/new-zealand-health-survey and for smoking rates by district, see https://www.health.govt.nz/publications/regional-results-2017-2020-new-zealand-health-survey.
In addition to smoking, other important risk factors for COPD include exposure to second-hand smoke, occupational lung irritants, air pollution, and genetic factors such as alpha-1 antitrypsin deficiency. These factors contribute to the development and progression of COPD, but they are not well captured in administrative data. Therefore, the COPD rates reported in this analysis should be interpreted with caution.
Hospital admissions with primary diagnosis of COPD are higher in some population groups
COPD admission rate among the PHO-enrolled population
In 2023, nearly 7,400 people (~ 3.5 per 1,000 of the PHO-enrolled population aged 45 years or over) were admitted to the hospital one or more times with a primary diagnosis of COPD. This was a slight decrease from 2018, when the rate was 3.9 per 1,000 of the PHO-enrolled population.
The highest admission rate was among those aged 75 years or above (8.5 per 1,000 PHO-enrolled population), compared to those aged 45–64 years (1.6 per 1,000) and 65–74 years (4.6 per 1,000). Across all age groups, Māori had the highest admission rate, and Asian population had the lowest rate. For example, among those aged 65–74 years, Māori (14.9 per 1,000 PHO enrolled population) and Pacific peoples (7.6 per 1,000 PHO enrolled population) were more likely to get admitted to a hospital with primary diagnosis of COPD than European/Other (3.9 per 1,000 PHO enrolled population) and Asian population (1.0 per 1,000 PHO enrolled population).
These rates also varied by district, ranging four-fold from 2.8 to 11.7 per 1,000 PHO-enrolled population among people aged 65–74 years, and more than 2.5-fold among those aged 75 years or above (6.1 to 15.8 per 1,000 PHO enrolled population). Rates varied by gender, for example, among those aged 75 years or above, males (9.1 per 1,000 PHO enrolled population) had significantly higher admission rate when compared to females (7.9 per 1,000 PHO enrolled population).
COPD admission rate among people with COPD (COPD cohort)
In 2023, about 11.1 percent of the PHO-enrolled population aged 45 years or over with COPD were admitted to the hospital one or more times with a primary diagnosis of COPD. This represents a decline from 16.3 percent in 2018. Across all age groups, Pacific peoples had the highest admission rate (14.5 percent), followed by Māori (12.9 percent). One possible explanation for this decrease could be the increase in LAMA dispensing, which may have led to better management of COPD symptoms and fewer hospital admissions. The increase in LAMA dispensing would have also expanded the denominator of people with COPD, which might contribute to the observed decrease in the hospitalisation rate.
Māori and Pacific peoples had the highest rates of admission to hospital with a diagnosis of COPD. This finding was true for both measures looking into admissions to hospital with the PHO-enrolled population, and for the COPD cohort.
About 3% of people aged 45 years or over with COPD were admitted to hospital two or more times with primary diagnosis of COPD.
In 2023, about 1,800 people (approximately 0.9 per 1,000 PHO enrolled population aged 45 years or over) were admitted to the hospital two or more times with a primary diagnosis of COPD, a slight decrease from 2018 (about 1 per 1,000 PHO enrolled population). Māori had higher rates of recurrent admissions (2.4 per 1,000 PHO enrolled population) compared to other ethnic groups: Pacific peoples (1.0 per 1,000 population), European/Other (0.8 per 1,000 population), and Asians (0.1 per 1,000 population).
Nearly half of people with COPD regularly received triple therapy
Triple therapy, consisting of a long-acting muscarinic antagonist (LAMA), long-acting beta agonist (LABA), and inhaled corticosteroid (ICS), is recommended as the comprehensive approach to COPD management. This combination improves airflow, reduces inflammation, and minimises symptoms and exacerbations.
In 2023, about 48.6 percent of people with COPD regularly received triple therapy. These rates were consistent over time (2018–2023). Rates differed by gender. For example, females (51.3 percent) aged 45–64 years had significantly higher dispensing rates of triple therapy when compared to males (46.1 percent) in that age group. Ethnic differences are more pronounced in the younger cohort. For example, among those aged 45–64 years with COPD, triple therapy dispensing rates are highest among Māori (51.1 percent), followed by European/Other (48.8 percent), Pacific peoples (47.9 percent) and Asians (44.9 percent). These rates also varied by district; ranged from 41.9-56.5 percent among those aged 65–74 years with COPD.
About 60 percent of those admitted to hospital with a primary diagnosis of COPD regularly received triple therapy in the following 12 months
The 2021 NZ COPD guidelines recommend that practitioners consider escalating to triple LABA/LAMA/ICS therapy for patients who continue to experience exacerbations despite adherence to dual LAMA/LABA or ICS/LABA therapy. This approach aims to optimise symptom control, reduce exacerbations, and improve long-term outcomes for individuals with persistent or severe COPD. In 2023, about 58.6 percent those admitted to hospital regularly received triple therapy in the following 12 months after admission, this increased from 51.2 percent in 2019.
Two-thirds of those with COPD who received two or more courses of prednisone regularly received triple therapy in the following 12 months
Prednisone is commonly prescribed during acute exacerbations of COPD to reduce inflammation and improve airflow. While it is effective in managing short-term flare-ups, repeated use of prednisone, especially through multiple courses, without optimal COPD management may indicate poorly controlled COPD or frequent exacerbations. This pattern of frequent steroid use suggests that the patient's underlying condition may not be adequately managed, and further evaluation or adjustments to the treatment regimen may be necessary to better control symptoms, prevent exacerbations, and improve overall disease management.
In 2023, about two-thirds (67.8 percent) of individuals with COPD who received two or more courses of prednisone also regularly received triple therapy (LABA/LAMA/ICS) in the following 12 months. This suggests that despite the use of systemic corticosteroids to manage exacerbations, these patients continued to require escalated therapy with triple inhaler regimens to better control their symptoms and reduce the frequency of flare-ups. This underscores the need for a comprehensive approach to manage COPD in patients with frequent exacerbations, ensuring adequate control of the disease and improving long-term outcomes.
These rates are lowest among those aged 75+ years (64.6 percent) when compared to those aged 45–64 years (69.9 percent) and 65–74 years (69.2 percent). Rates varied 1.5-fold by Health New Zealand district for those aged 75 years or over ranging from 53.9 percent to 75.6 percent.
Among those aged 45 years or over, Pacific peoples and Māori have higher regular dispensing rates of SABA monotherapy without any preventer medication
Short-Acting Beta Agonists (SABA) are commonly used for acute symptom relief and recommended as an initial treatment for COPD but are not sufficient as a standalone treatment for long-term control. Using SABA excessively (as the sole treatment) without optimal COPD treatment can be harmful, leading to poor disease control and potentially more frequent exacerbations [1].
We found that regular SABA monotherapy dispensing rates have slightly decreased over time from 1.1 percent in 2018 to 0.9 percent in 2023. Those aged 75 years or over (1.0 percent) have higher rates of regular SABA monotherapy dispensing than younger age groups (0.9 percent for those aged 65–74 years and 0.8 percent for 45–64 years).
Across all age groups, Pacific peoples and Māori have higher rates of regular SABA monotherapy dispensing than other ethnic groups. For example, among those aged 65–74 years, Pacific peoples have highest rate of 1.9 percent followed by Māori (1.6 percent), European/Other (0.8 percent) and Asians (0.8 percent).
In 2023, regular SABA monotherapy dispensing rates varied more than two-fold by district, from 0.6 percent to 1.5 percent in those aged 65–74 years and 0.7-1.5 percent in those aged 75 years or above. When interpreting the indicator, it's important to keep in mind that the denominator for this indicator is PHO enrolled population that could comprise both COPD and asthma patients.
What questions might the data prompt?
- Why do some districts have consistently lower or higher rates than the national mean?
- What barriers might exist that prevent people from accessing health care and collecting their medications?
- What are the socioeconomic and commercial determinants of health (eg, marketing of tobacco) that might contribute to the higher prevalence of COPD among some subgroups?
- How do districts with population distribution compare?
- What community programmes are available? Are they culturally tailored to Māori and Pacific populations?
- Do these rates differ by rurality? How does living rurally affect the outcome?
- At the practice level, how many practices have a mechanism to identify patients who have had a COPD admission and follow up if they have not rebooked within a specific timeframe to review their medications?
Background
Chronic obstructive pulmonary disease (COPD) encompasses chronic bronchitis, emphysema, and chronic airflow obstruction. It is characterised by persistent respiratory symptoms and airflow limitation that is not fully reversible.
Chronic bronchitis is defined as daily sputum production for at least three months of two or more consecutive years. Emphysema is a pathological condition involving alveolar dilation and destruction. Breathlessness with exertion, chest tightness, and wheezing are the results of airway narrowing and impaired gas exchange. The loss of lung elastic tissue in emphysema may lead to airway wall collapse during expiration, resulting in dynamic hyperinflation and an increased work of breathing.
Chronic obstructive pulmonary disease (sometimes called chronic obstructive respiratory disease) is the fourth most common cause of death in Aotearoa New Zealand and the third most common cause of death in the Māori population [2]. A recent report by Health New Zealand stated that COPD is the third most common avoidable cause of death that is contributing to the life expectancy gap between Māori females and the non-Māori, non-Pacific population, and the sixth most common cause for Māori males [3] .
Method and data source
The Atlas domain draws on existing national data collections held by Health New Zealand, including the National Minimum Dataset, the Pharmaceutical Collection, and the Primary Health Organisation Enrolment Collection. Unlike other atlases, this atlas uses total response ethnicity grouping rather than prioritised ethnicity grouping. In this approach, individuals who identify with more than one ethnicity have all the ethnicities they identify with recorded. For example, if someone identifies as both Māori and Pacific, they will be counted in both ethnic categories. This method provides a more inclusive count of all ethnicities, recognising that individuals may belong to multiple ethnic groups.
The indicators looking at admissions to hospital for COPD include data for emergency department attendances meeting the three-hour rule for hospital admissions. This is because different districts handle emergency department attendances differently. For more information, see the methodology (606KB, pdf).
Limitations
The Pharmaceutical Collection contains claim and payment information from community pharmacists for subsidised dispensing. This collection does not reflect adherence or whether the medication was taken effectively. Over-the-counter medicines are not included. Note our definition of regular medication use only includes people receiving medication for two or more quarters in a year. It should be noted that we did not take into account people who initiate medication later in the year.
There is no ideal rate of medicine use in people with COPD because it depends on clinical need. However, wide variation between districts or ethnic groups raises questions as to why the rate of medicine use varies. Please note that Pharmaceutical Collection has only dispensing information but not prescribing information. This limits our ability to fully understand prescribing patterns, adherence, or discrepancies between prescribed and dispensed medications.
Relationship with other health system activities
Respiratory disease, including COPD, has been identified as one of the five priority focus areas by the New Zealand government in the Government Policy Statement on Health 2024-2027 [4]. This recognition reflects the growing concern over the burden of respiratory conditions on the healthcare system and the well-being of New Zealanders. To address this issue, the government has outlined specific actions and strategies aimed at improving the management of respiratory diseases, including COPD, across the country. One key aspect of the government's approach is the inclusion of an indicator measuring hospitalisations due to COPD
Acknowledgements
Te Tāhū Hauora would like to acknowledge Pharmac – Te Pātaka Whaioranga for supporting this work.
References
1. Janson C, Wiklund F, Telg G, Stratelis G, Sandelowsky H. High use of short-acting β2-agonists in COPD is associated with an increased risk of exacerbations and mortality. ERJ Open Res. 2023 Jun 19;9(3):00722-2022. doi: 10.1183/23120541.00722-2022
2. Asthma and Respiratory Foundation NZ. 2024. Understanding COPD. Wellington: Asthma and Respiratory Foundation NZ. URL: https://www.asthmafoundation.org.nz/stories/understanding-copd
3. Health New Zealand | Te Whatu Ora. 2024. Life Expectancy in Aotearoa New Zealand: An Analysis of Socioeconomic, Geographic, Sex and Ethnic Variation from 2001 to 2022. Wellington: Health New Zealand. URL: https://www.tewhatuora.govt.nz/publications/life-expectancy-in-aotearoa-an-analysis-of-socioeconomic-geographic-sex-and-ethnic-variation-from-2001-to-2022
4. Minister of Health. 2024. Government Policy Statement on Health 2024 – 2027. Wellington: Ministry of Health. URL: https://www.health.govt.nz/system/files/2024-06/government-policy-statement-on-health-2024-2027-v4.pdf
Recommended reading/suggested links
- Asthma and Respiratory Foundation NZ. 2024. NZ COPD guidelines. Wellington: Asthma and Respiratory Foundation NZ. URL: https://www.nzrespiratoryguidelines.co.nz/uploads/8/3/0/1/83014052/nz_copd_guidelines_web.pdf
- Health New Zealand | Te Whatu Ora. 2024. Chronic obstructive pulmonary disease (COPD). Wellington: Health New Zealand. URL:https://info.health.nz/conditions-treatments/lungs/chronic-obstructive-pulmonary-disease
- Te Tāhū Hauora | Health Quality and Safety Commission 2023. Chronic obstructive pulmonary disease (COPD) | He mate puru ia auraki (Frailty care guides 2023). Wellington: Te Tāhū Hauora. URL: https://www.hqsc.govt.nz/resources/resource-library/chronic-obstructive-pulmonary-disease-copd-he-mate-puru-ia-auraki-frailty-care-guides-2023/
- Healthify | He Puna Waiora 2024. COPD | Mate ia tuku. URL:https://healthify.nz/health-a-z/c/copd/
- Asthma and Respiratory Foundation NZ. 2024. COPD. Wellington: Asthma and Respiratory Foundation NZ. URL: https://www.asthmafoundation.org.nz/resources/topic/copd
Published: 18 Dec 2024
Modified: 18 Dec 2024
