Half of COPD Inhaler Use Does Not Align With GOLD Recommendations

Half of patients with COPD report use of inhaler medications that are not in alignment with the current treatment recommendations.

Approximately half of patients with chronic obstructive pulmonary disease (COPD) who use inhaler medications report use that is not in alignment with current treatment recommendations, according to an analysis of participants in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS).

Participants filled out annual questionnaires regarding inhaled medication use and investigators collected data from 4 years. Inhaled medications were classified as long-acting muscarinic receptor antagonists, long-acting beta-agonists, inhaled corticosteroids (ICS), and combination medications. Participants included in the analysis had spirometry-defined COPD (ie, postbronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity <0.70) at the time of first visit. Complete 2011 Global Initiative for Obstructive Lung Disease (GOLD) categorization and data on medication use at baseline (n=1721) were available for all participants.

Self-reported data on demographics, smoking status and history, inhaler medication use, and COPD exacerbations (ie, any respiratory flare-up requiring healthcare utilization that included receiving antibiotics and/or systemic corticosteroids) in the previous 12 months were collected. Researchers assigned participants to the 2011 GOLD COPD categories A (n=383), B (n=665), C (n=75), or D (n=598). Participants were stratified into aligned with inhaler regimen to first- or second-line GOLD recommendations (n=888) or nonaligned with recommendations (n=833). The nonaligned group was further categorized into overuse (n=384) and underuse (n=449) groups.

Underuse of medications in patients with nonaligned regimens was primarily the result of a lack of long-acting inhaler use in the GOLD D category. In the overuse group, 95% of participants were treated with nonindicated ICS-containing therapies. Of participants with 4-year follow-up data available for analysis, 431 had no change in alignment with recommendations over time. In a comparison analysis between 2011 and 2017 recommendations, the investigators found that 47% and 35% of participants did not align with either 2011 or 2017 recommendations or did align with both recommendations, respectively.

The self-reported nature of the data on COPD exacerbations, smoking history, and medication use was the main limitation of the study.

Considering the continual changes in the “landscape of classifying and treating [patients with] COPD, improvement of dissemination and uptake of published recommendations has the potential to improve care,” the researchers concluded.

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Disclosures: The SPIROMICS study was partially funded by AstraZeneca/MedImmune, Bayer, Bellerophon Therapeutics, Boehringer Ingelheim, GlaxoSmithKline, and Novartis, among other pharmaceutical companies.


Ghosh S, Anderson WH, Putcha N, et al; for the SPIROMICS Investigators. Alignment of inhaled COPD therapies with published strategies: analysis of the GOLD recommendations in SPIROMICS [published online September 14, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201804-283OC