Alignment of inhaled chronic obstructive pulmonary disease therapies with published strategies :analysis of the Global Initiative for Chronic Obstructive Lung Disease recommendations in SpiroMics
Creators: name: Hoffman, E.A.
name: Hansel, N.N.
name: Kleerup, E.C.
name: Galban, C.
name: Tashkin, D.P.
name: Putcha, N.
name: Krishnan, J.A.
name: Wise, R.A.
name: Christenson, S.A.
name: Bhatt, S.P.
name: Lazarus, S.C.
name: Alexis, N.E.
name: Hastie, A.T.
name: LaVange, L.M.
name: Woodruff, P.G.
name: Boucher, R.C.
name: Paine, R., III
name: Postow, L.
name: Graham Barr, R.
name: Rennard, S.I.
name: Arjomandi, M.
name: Viviano, L.
name: Doerschuk, C.M.
name: Putcha, N.
name: Curtis, J.L.
name: Kaner, R.J.
name: Couper, D.J.
name: Kanner, R.E.
name: Anderson, W.H.
name: Cooper, C.B.
name: Moore, W.C.
name: Ghosh, S.
name: Paulin, L.
name: Bleecker, E.R.
name: Meyers, D.A.
name: Bowler, R.P.
name: Dransfield, M.T.
name: Martinez, F.J.
name: O&apos;Neal, W.K.
name: Ortega, V.E.
name: Michael Wells, J.
name: Freeman, C.M.
name: Bateman, L.A.
name: Han, M.K.
name: Huang, Y.
name: Bradley Drummond, M.
name: Crystal, R.G.
name: Raman, S.
name: Peters, S.P.
name: Drummond, B.
name: Criner, G.J.
name: Newell, J.D., Jr.
name: Oelsner, E.C.
name: Barjaktarevic, I.
name: Comellas, A.P.
name: Pirozzi, C.
Publisher: name: American Thoracic Society
Year: 2019

description: Rationale: Despite awareness of chronic obstructive pulmonary disease (COPD) treatment recommendations, uptake is poor. The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) spans 2010-2016, providing an opportunity to assess integration of 2011 Global Initiative for Obstructive Lung Disease (GOLD) treatment strategies over time in a large observational cohort study. Objectives: To evaluate how COPD treatment aligns with 2011 GOLD strategies and determine factors associated with failure to align with recommendations. Methods: Information on inhaled medication use collected via questionnaire annually for 4 years was compiled into therapeutic classes (long-acting antimuscarinic agent, long-acting b-agonist, inhaled corticosteroids [ICS], and combinations thereof). Medications were not modified by SPIROMICS investigators. 2011 GOLD COPD categories A, B, C, and D were assigned. Alignment of inhaler regimen with first-/second-line GOLD recommendations was determined, stratifying into recommendation aligned or nonaligned. Recommendation-nonaligned participants were further stratified into overuse and underuse categories. Results: Of 1,721 participants with COPD, at baseline, 52% of regimens aligned with GOLD recommendations. Among participants with nonaligned regimens, 46% reported underuse, predominately owing to lack of long-acting inhalers in GOLD category D. Of the 54% reporting overuse, 95% were treated with nonindicated ICS-containing regimens. Among 431 participants with 4 years of follow-up data, recommendation alignment did not change over time. When we compared 2011 and 2017 recommendations, we found that 47% did not align with either set of recommendations, whereas 35% were in alignment with both recommendations. Conclusions: Among SPIROMICS participants with COPD, nearly 50% reported inhaler regimens that did not align with GOLD recommendations. Nonalignment was driven largely by overuse of ICS regimens in milder disease and lack of long-acting inhalers in severe disease.