期刊
ANNALS OF THE AMERICAN THORACIC SOCIETY
卷 16, 期 2, 页码 200-208出版社
AMER THORACIC SOC
DOI: 10.1513/AnnalsATS.201804-283OC
关键词
chronic obstructive pulmonary disease; inhaled therapy; treatment
资金
- National Institutes of Health (NIH) [R01HL125432-01A1, T32HL007106-41]
- NIH/National Heart, Lung, and Blood Institute [HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C]
- Foundation for the National Institutes of Health
- COPD Foundation from AstraZeneca/MedImmune
- Bayer
- Bellerophon Therapeutics
- Boehringer-Ingelheim Pharmaceuticals, Inc.
- Chiesi Farmaceutici S.p.A.
- Forest Research Institute, Inc.
- GlaxoSmithKline
- Grifols Therapeutics, Inc.
- Ikaria, Inc.
- Nycomed GmbH
- Takeda Pharmaceutical Company
- Novartis Pharmaceuticals Corporation
- ProterixBio
- Regeneron Pharmaceuticals, Inc.
- Sanofi
- Sunovion
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 beta-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.
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