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Observational Study
. 2019 Feb;16(2):200-208.
doi: 10.1513/AnnalsATS.201804-283OC.

Alignment of Inhaled Chronic Obstructive Pulmonary Disease Therapies with Published Strategies. Analysis of the Global Initiative for Chronic Obstructive Lung Disease Recommendations in SPIROMICS

Sohini Ghosh  1 , Wayne H Anderson  2 , Nirupama Putcha  3 , Meilan K Han  4 , Jeffrey L Curtis  4 , Gerard J Criner  5 , Mark T Dransfield  6 , R Graham Barr  7 , Jerry A Krishnan  8 , Stephen C Lazarus  9 , Christopher B Cooper  10 , Robert Paine 3rd  11 , Stephen P Peters  12 , Nadia N Hansel  3 , Fernando J Martinez  13 , M Bradley Drummond  1 ; Current and former investigators of the SPIROMICS sites and reading centers
Collaborators, Affiliations
Observational Study

Alignment of Inhaled Chronic Obstructive Pulmonary Disease Therapies with Published Strategies. Analysis of the Global Initiative for Chronic Obstructive Lung Disease Recommendations in SPIROMICS

Sohini Ghosh et al. Ann Am Thorac Soc. 2019 Feb.

Abstract

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 β-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.

Keywords: chronic obstructive pulmonary disease; inhaled therapy; treatment.

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Figures

Figure 1.
Figure 1.
Proportion of Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) participants aligning with Global Initiative for Chronic Obstructive Lung Disease (GOLD) first- or second-line treatment recommendations, stratified by baseline GOLD group.
Figure 2.
Figure 2.
Distribution of overuse and underuse among Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) participants not aligning with Global Initiative for Chronic Obstructive Lung Disease (GOLD) first- or second-line treatment recommendations, stratified by baseline GOLD group.
Figure 3.
Figure 3.
Change in alignment with first- or second-line Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations over follow-up visits among 431 SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) participants with complete follow-up data.
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References

    1. Overington JD, Huang YC, Abramson MJ, Brown JL, Goddard JR, Bowman RV, et al. Implementing clinical guidelines for chronic obstructive pulmonary disease: barriers and solutions. J Thorac Dis. 2014;6:1586–1596. - PMC - PubMed
    1. Grimshaw JM, Schünemann HJ, Burgers J, Cruz AA, Heffner J, Metersky M, et al. ATS/ERS Ad Hoc Committee on Integrating and Coordinating Efforts in COPD Guideline Development. Disseminating and implementing guidelines: article 13 in integrating and coordinating efforts in COPD guideline development: an official ATS/ERS workshop report. Proc Am Thorac Soc. 2012;9:298–303. - PubMed
    1. Global Initiative for Chronic Lung Disease (GOLD) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2018 report[accessed 2018 Jul 30]. Available from: www.goldcopd.org
    1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med. 2001;163:1256–1276. - PubMed
    1. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–365. - PubMed

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