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 language | English (US) |
|---|---|
| Pages (from-to) | 200-208 |
| Number of pages | 9 |
| Journal | Annals of the American Thoracic Society |
| Volume | 16 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2019 |
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Keywords
- Chronic obstructive pulmonary disease
- Inhaled therapy
- Treatment
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
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.
In: Annals of the American Thoracic Society, Vol. 16, No. 2, 01.02.2019, p. 200-208.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85060926042&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060926042&partnerID=8YFLogxK
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 -