Alignment of Inhaled COPD Therapies with Published Strategies: Analysis of the GOLD Recommendations in SPIROMICS.

TitleAlignment of Inhaled COPD Therapies with Published Strategies: Analysis of the GOLD Recommendations in SPIROMICS.
Publication TypePublication
AuthorsGhosh S, Anderson WH, Putcha N, Han MK, Curtis JL, Criner GJ, Dransfield MT, R Barr G, Krishnan JA, Lazarus SC, Cooper CB, Paine R, Peters SP, Hansel NN, Martinez FJ, M Drummond B
Corporate AuthorsSPIROMICS Investigators
JournalAnn Am Thorac Soc
Date Published2018 Sep 14

RATIONALE: Despite awareness of 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.OBJECTIVE: To evaluate how COPD treatment aligns with 2011 GOLD strategies and determine factors associated with failure to align with recommendations.METHODS: Inhaled medication use collected via questionnaire annually for four years was compiled into therapeutic classes (LAMA, LABA, ICS and combinations). Medications were not modified by SPIROMICS investigators. 2011 GOLD COPD categories A, B, C, or D were assigned. Alignment of inhaler regimen to 1st/2nd line GOLD recommendations were determined, stratifying into recommendation aligned or nonaligned. Recommendation nonaligned participants were further stratified into overuse and underuse.RESULTS: Of 1721 COPD participants, at baseline 52% of regimens aligned with GOLD recommendations. Among participants with nonaligned regimens, 46% reported underuse, predominately due to lack of long-acting inhaler in GOLD-D. Of the 54% reporting overuse, 95% were treated with nonindicated ICS-containing regimens. Among 431 participants with four years of follow-up data, recommendation alignment did not change over time. When comparing 2011 and 2017 recommendations, 47% did not align with either recommendations while 35% were in alignment with both recommendations.CONCLUSIONS: Among SPIROMICS COPD participants, 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.

Alternate JournalAnn Am Thorac Soc
PubMed ID30216731
Grant ListK24 HL138188 / HL / NHLBI NIH HHS / United States
R01 HL125432 / HL / NHLBI NIH HHS / United States
Manuscript Lead/Corresponding Author Affiliation: 
Genomics and Informatics Center (University of North Carolina at Chapel Hill)
Manuscript Status: 
Published and Public