Classification of Patients with COPD on LAMA Monotherapy Using the GOLD Criteria: Analysis of a Claims-Linked Patient Survey Study

Ray, Riju; Hahn, Beth; Stanford, Richard H.; White, John; Essoi, Breanna; Hunter, Alyssa Goolsby

doi:10.1007/s41030-019-00099-0

Cited by 4 publications

(2 citation statements)

References 44 publications

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“…No GOLD Group D patient was overtreated, as in the TOLD study [ 11 ]. The reasons for all these findings may be the fact that this category of patients, with a high-symptom burden and high-risk of exacerbation, usually receives the maximal therapy (LAMA + LABA + ICS) if further exacerbations occur [ 1 , 33 ], and overtreatment is not possible.…”

Section: Discussionmentioning

confidence: 99%

Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve

Râjnoveanu

Ardelean

et al. 2020

Medicina

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Background and objectives: Data about pulmonologist adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines showed a great variability and cannot be extrapolated. The present study investigates the current pharmacological prescribing practices in the treatment of chronic obstructive pulmonary disease (COPD) according to the 2017 GOLD guidelines, to determine the level of pulmonologist adherence and to identify possible factors that influence physician adherence. Materials and methods: This retrospective study took place between 1 February and 30 April 2018 in Pneumophtysiology Clinical Hospital Cluj-Napoca. We included 348 stable COPD outpatients classified according to the 2017 GOLD strategy in the ABCD risk groups. Pulmonologist adherence was defined as appropriate if the recommended pharmacological therapy was the first- or alternative-choice drug according to the guidelines, and inappropriate (overtreatment, undertreatment) if it was not in line with these recommendations. Results: The most prescribed treatment was the combination long-acting beta agonist (LABA) + long-acting antimuscarinic agent (LAMA) (34.77%), followed by LAMA + LABA + inhaled corticosteroid (ICS). Overall, pneumologist adherence was 79.02%. The most inappropriate therapies were in Group B (33.57%), followed by 33.33% in Group A. Compared to Groups C and D (analyzed together), Groups A and B had a 4.65 times higher chance (p = 0.0000001) of receiving an inappropriate therapy. Patients with cardiovascular comorbidities had a 1.89 times higher risk of receiving an inappropriate therapy (p = 0.021). ICS overprescription was the most common type of inappropriateness (17.81%). Groups C and D had a 3.12 times higher chance of being prescribed ICS compared to Groups A and B (p = 0.0000004). Conclusions: Pulmonologist adherence to the GOLD guidelines is not optimal and needs to be improved. Among the factors that influence the inappropriateness of COPD treatments, cardiovascular comorbidities and low-risk Groups A and B are important. ICS represent the most prescribed overtreatment. Further multicentric studies are needed to evaluate all factors that might influence the adherence rate.

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Section: Discussionmentioning

confidence: 99%

Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve

Râjnoveanu

Ardelean

et al. 2020

Medicina

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“…Our retrospective analysis of 119 patients showed a similar percentage (38.7%) is not admitted on an LA inhaler for acute exacerbations. Studies show discrepancies between guidelines and real-world practice [ 7 – 10 ]. For example, one cross-sectional study of 55,361 COPD patients looking at prescriber adherence to GOLD recommended care of COPD patients and found that 36% of COPD patients and history of at least one exacerbation were not receiving long-acting maintenance inhaler therapy [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

LA inhalers for COPD: perceptions/reality of ABCD GOLD tool use

Boryushkina

Kumar

Barnes

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) created an ABCD tool to assess staging and severity of COPD subgroups that respond to LAMA or LABA with improved quality of life and reduced exacerbations. Our study assesses perception of physicians at five community hospitals towards LAMA use for patients admitted with COPD exacerbations according to the GOLD guidelines and describes the experience at our hospital. Methods: Electronic survey forms regarding LAMA use and the GOLD criteria ABCD for COPD treating physicians were sent to five hospitals. A one-year chart review at our hospital determined prevalent use of a maintenance LAMA or LABA inhaler in patients admitted with acute COPD exacerbation. Currently, our EMR does not require a field for the GOLD ABCD categorization. Results: We obtained a 33% (45/136) response rate. Of these, 63% felt a LAMA to be essential on formulary; 60% were neutral or unlikely to initiate LAMA on admission; 47.7% likely or very likely to start a LAMA during hospitalization; 82% were neutral to very likely to discharge a patient on a LAMA if deemed necessary for maintenance. Of those admitted for acute COPD exacerbations to our hospital, over a third of COPD patients were not on a maintenance LAMA or LABA. Conclusions: Most physicians felt it important to prescribe a maintenance LAMA to COPD patients hospitalized for acute exacerbation. Our hospital's use of LAMA or LABA demonstrates the need to incorporate strategies to encourage appropriate prescribing of these LA inhalers per GOLD guidelines.

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An evaluation of Chronic Obstructive Pulmonary Disease (COPD) management within the healthcare System of Pakistan: Insights from a Cross-Sectional analysis of GOLD Guidelines implementation

Kanwal,

Khan,

Kalsoom

et al. 2024

Preprint

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Background: Recognizing the significance of standardized treatment guidelines in managing COPD, this study aimed to explore prescription patterns in the treatment of chronic obstructive pulmonary disease (COPD). The primary objectives were to assess the extent to which pulmonologists adhere to these guidelines and to pinpoint any factors that may influence physician adherence. Methodology: The research was conducted from April to September 2022 in various healthcare facilities within the twin cities of Pakistan. COPD outpatients were categorized into different risk groups (ABCD) in accordance with the 2021 GOLD strategy. In the context of COPD management, physicians' clinical practices were evaluated by examining both the patients' disease status and the treatment regimens prescribed to determine the degree of adherence to established guidelines. Results: The study included 182 patients, mostly (73.6%) were male with the age mean ± SD 61.16 ± 11.004 years. All patients were Asian Pakistani (100%); 102 (56.0%) patients lived in urban areas, and 80 (44.0%) in rural areas. The most prescribed treatment was the combination long-acting beta agonist (LABA) (27.5%), followed by combination therapy LAMA + LABA (in different inhalers) ((21.4%), LAMA (17.0%), and LABA + ICS (13.7%).The most inappropriate therapies were in Group A (56.09%) followed by a7.5% in Group C. Patients with cardiovascular comorbidities had a .479 (95% CI, .264-.868) times higher risk of receiving an inappropriate therapy (p = 0.015). Conclusions: Pulmonologist compliance with the GOLD guidelines falls short of the desired level and necessitates enhancement. Among the influential factors contributing to the inadequacy of COPD treatments, cardiovascular comorbidities and the inclusion of low-risk Groups A and B are notable, as they carry an elevated risk of overtreatment. Furthermore, it is noteworthy that LABA, while being the most frequently prescribed therapy, is not aligned with the guideline's recommendations to a substantial extent.

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Classification of Patients with COPD on LAMA Monotherapy Using the GOLD Criteria: Analysis of a Claims-Linked Patient Survey Study

Cited by 4 publications

References 44 publications

Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve

Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve

LA inhalers for COPD: perceptions/reality of ABCD GOLD tool use

An evaluation of Chronic Obstructive Pulmonary Disease (COPD) management within the healthcare System of Pakistan: Insights from a Cross-Sectional analysis of GOLD Guidelines implementation

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