Alignment of inhaled chronic obstructive pulmonary disease therapies with published strategies :analysis of the Global Initiative for Chronic Obstructive Lung Disease recommendations in SpiroMics

SPIROMICS investigators

Research output: Contribution to journalArticle

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 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.

Original languageEnglish (US)
Pages (from-to)200-208
Number of pages9
JournalAnnals of the American Thoracic Society
Volume16
Issue number2
DOIs
StatePublished - Feb 1 2019

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Obstructive Lung Diseases
Chronic Obstructive Pulmonary Disease
Nebulizers and Vaporizers
Adrenal Cortex Hormones
Outcome Assessment (Health Care)
Therapeutics
Muscarinic Antagonists
Observational Studies
Cohort Studies
Research Personnel

Keywords

  • Chronic obstructive pulmonary disease
  • Inhaled therapy
  • Treatment

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{ba8295f640d84b4e8fd43ebb4c6a1b9d,
title = "Alignment of inhaled chronic obstructive pulmonary disease therapies with published strategies :analysis of the Global Initiative for Chronic Obstructive Lung Disease recommendations in SpiroMics",
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 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.",
keywords = "Chronic obstructive pulmonary disease, Inhaled therapy, Treatment",
author = "{SPIROMICS investigators} and Sohini Ghosh and Anderson, {Wayne H.} and Nirupama Putcha and Han, {Meilan K.} and Curtis, {Jeffrey L.} and Criner, {Gerard J.} and Dransfield, {Mark T.} and {Graham Barr}, R. and Krishnan, {Jerry A.} and Lazarus, {Stephen C.} and Cooper, {Christopher B.} and Robert Paine and Peters, {Stephen P.} and Nadia Hansel and Martinez, {Fernando J.} and {Bradley Drummond}, M. and Alexis, {Neil E.} and Mehrdad Arjomandi and Igor Barjaktarevic and Bateman, {Lori A.} and Bhatt, {Surya P.} and Bleecker, {Eugene R.} and Boucher, {Richard C.} and Bowler, {Russell P.} and Christenson, {Stephanie A.} and Comellas, {Alejandro P.} and Couper, {David J.} and Crystal, {Ronald G.} and Doerschuk, {Claire M.} and Brad Drummond and Freeman, {Christine M.} and Craig Galban and Hastie, {Annette T.} and Hoffman, {Eric A.} and Yvonne Huang and Kaner, {Robert J.} and Kanner, {Richard E.} and Kleerup, {Eric C.} and LaVange, {Lisa M.} and Meyers, {Deborah A.} and Moore, {Wendy C.} and Newell, {John D.} and Laura Paulin and Cheryl Pirozzi and Nirupama Putcha and Oelsner, {Elizabeth C.} and O'Neal, {Wanda K.} and Ortega, {Victor E.} and Sanjeev Raman and Wise, {Robert A}",
year = "2019",
month = "2",
day = "1",
doi = "10.1513/AnnalsATS.201804-283OC",
language = "English (US)",
volume = "16",
pages = "200--208",
journal = "Annals of the American Thoracic Society",
issn = "2325-6621",
publisher = "American Thoracic Society",
number = "2",

}

TY - JOUR

T1 - Alignment of inhaled chronic obstructive pulmonary disease therapies with published strategies :analysis of the Global Initiative for Chronic Obstructive Lung Disease recommendations in SpiroMics

AU - SPIROMICS investigators

AU - Ghosh, Sohini

AU - Anderson, Wayne H.

AU - Putcha, Nirupama

AU - Han, Meilan K.

AU - Curtis, Jeffrey L.

AU - Criner, Gerard J.

AU - Dransfield, Mark T.

AU - Graham Barr, R.

AU - Krishnan, Jerry A.

AU - Lazarus, Stephen C.

AU - Cooper, Christopher B.

AU - Paine, Robert

AU - Peters, Stephen P.

AU - Hansel, Nadia

AU - Martinez, Fernando J.

AU - Bradley Drummond, M.

AU - Alexis, Neil E.

AU - Arjomandi, Mehrdad

AU - Barjaktarevic, Igor

AU - Bateman, Lori A.

AU - Bhatt, Surya P.

AU - Bleecker, Eugene R.

AU - Boucher, Richard C.

AU - Bowler, Russell P.

AU - Christenson, Stephanie A.

AU - Comellas, Alejandro P.

AU - Couper, David J.

AU - Crystal, Ronald G.

AU - Doerschuk, Claire M.

AU - Drummond, Brad

AU - Freeman, Christine M.

AU - Galban, Craig

AU - Hastie, Annette T.

AU - Hoffman, Eric A.

AU - Huang, Yvonne

AU - Kaner, Robert J.

AU - Kanner, Richard E.

AU - Kleerup, Eric C.

AU - LaVange, Lisa M.

AU - Meyers, Deborah A.

AU - Moore, Wendy C.

AU - Newell, John D.

AU - Paulin, Laura

AU - Pirozzi, Cheryl

AU - Putcha, Nirupama

AU - Oelsner, Elizabeth C.

AU - O'Neal, Wanda K.

AU - Ortega, Victor E.

AU - Raman, Sanjeev

AU - Wise, Robert A

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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.

KW - Chronic obstructive pulmonary disease

KW - Inhaled therapy

KW - Treatment

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U2 - 10.1513/AnnalsATS.201804-283OC

DO - 10.1513/AnnalsATS.201804-283OC

M3 - Article

C2 - 30216731

AN - SCOPUS:85060926042

VL - 16

SP - 200

EP - 208

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 2

ER -