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. 2015 Jun 19;2(3):223-235.
doi: 10.15326/jcopdf.2.3.2014.0151.

Effects of GOLD-Adherent Prescribing on COPD Symptom Burden, Exacerbations, and Health Care Utilization in a Real-World Setting

David M Mannino  1 , Tzy-Chyi Yu  2 , Huanxue Zhou  3 , Keiko Higuchi  2
Affiliations

Effects of GOLD-Adherent Prescribing on COPD Symptom Burden, Exacerbations, and Health Care Utilization in a Real-World Setting

David M Mannino et al. Chronic Obstr Pulm Dis. .

Abstract

Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines recommend specific drug therapy protocols for chronic obstructive pulmonary disease (COPD) patients based on symptoms and exacerbation risk. This study used electronic health records (EHRs) to assess the effect of adherence and nonadherence to GOLD prescribing guidelines on COPD symptom burden, exacerbations, and health care resource utilization (HCRU) during the 180 days following index treatment start. Included patients had COPD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 490.xx, 491.xx, 492.xx, 496.xx), a valid GOLD stage within the study period (January 1, 2007 to December 31, 2012), and were 40 to 90 years of age at first GOLD staging (GOLD date). Adherence or nonadherence to GOLD-defined prescribing was based on COPD medication prescribed within 180 days on either side of the GOLD date. Of 4234 patients included in the analysis, approximately 36% were prescribed GOLD-adherent pharmacotherapy. Prevalence of all COPD-related symptoms during the 180 days following index treatment start were significantly reduced in the GOLD-adherent (n=1531) versus the GOLD-nonadherent group (n=2703). GOLD-adherent prescribing was associated with significant reductions in proportions of patients with all-cause hospitalizations and emergency department (ED) visits (unadjusted odds ratios [ORs], 0.69 and 0.63, respectively), as well as respiratory-specific ED visits (unadjusted OR, 0.65), compared with GOLD-nonadherent prescribing. In analyses that divided patients receiving GOLD-nonadherent treatment into undertreated and overtreated patients, undertreatment was associated with significant increases in many COPD symptoms, and both undertreatment and overtreatment were associated with increases in some HCRU endpoints. GOLD-adherent prescribing delivers moderate benefits with respect to COPD symptoms and HCRU.

Keywords: GOLD guidelines; health care resource utilization; pharmacotherapy; symptoms.

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Conflict of interest statement

D. Mannino has received consulting fees from GlaxoSmithKline plc, Novartis Pharmaceuticals, Pfizer, Inc., Boehringer-Ingelheim, AstraZeneca PLC, Forest Laboratories, Inc., Merck, Amgen, and Creative Educational Concepts. Furthermore, he has received royalties from Up-to-Date and is on the Board of Directors of the COPD Foundation. K. Higuchi and T.C. Yu are employees and stockholders of Novartis Pharmaceuticals Corporation. H. Zhou is an employee of KMK Consulting (providing services to Novartis Pharmaceuticals Corporation).

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