Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting more than 10 million Americans. Worldwide COPD is a disease of increasing public health importance as estimates suggest that COPD will rise from the fourth to the third most common cause of death by 2020. Increased exposure to risk factors and an aging population will attribute to even more patients with COPD. Adherence to guideline-recommended treatment regimens may decrease healthcare costs and improve patient outcomes. According to the GOLD guidelines, COPD pharmacotherapy recommendations are derived from the “ABCD” assessment tool, which takes into consideration a patient’s symptoms and their history of exacerbations (including prior hospitalizations). Symptom assessment is completed using either the Modified British Medical Research Council (mMRC) Questionnaire or the COPD Assessment Test (CAT). This is a change from the diagnostic criteria outlined in the 2010 NICE COPD Guidelines which recommend diagnosing stages of COPD based on stable-state forced expiratory volume in 1 second (FEV1). The 2017 GOLD Guidelines also place dual bronchodilators earlier than inhaled corticosteroids (ICS) in the stepwise progression of therapy based on symptoms (COPD assessment tool score) and rates of exacerbations. These changes were primarily made based on a few breakthrough studies including the FLAME and LANTERN trials which showed decreased exacerbations, improved quality of life measures, and decreased rates of pneumonia in patients on dual bronchodilators compared to LABA/ICS combinations. With these recent changes to the guidelines, it is necessary to evaluate the appropriateness of treatment regimens for patients with a diagnosis of COPD. The purpose of this study was to determine how hospitalizations for COPD exacerbation influence changes to maintenance inhaler therapy and adherence to practice guideline recommendations.
Swanson, Kalee N.; Keillor, Alissa PharmD; and Linn, Dustin D PharmD, BCPS, BCCCP, "Adherence to Guideline Recommended Treatment of COPD in Discharged Patients Following an Acute Exacerbation" (2018). Pharmacy. 31.