Impact of Clinical Guidelines on Inhaler Prescriptions for COPD Exacerbation Admissions
Recommended Citation
Mcintosh J, Jennings JH. Impact of Clinical Guidelines on Inhaler Prescriptions for COPD Exacerbation Admissions. Am J Respir Crit Care Med 2025; 211:A6176.
Document Type
Conference Proceeding
Publication Date
5-20-2025
Publication Title
Am J Respir Crit Care Med
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that is associated with significant morbidity and mortality. Long-acting muscarinic agonists (LAMAs) and long-acting beta agonists (LABAs) are two types of long-acting bronchodilators (LABDs) that have been shown to improve both symptoms of breathlessness and rates of exacerbations and hospitalizations. Recent GOLD guidelines recommend that patients who have had at least one COPD exacerbation leading to hospital admission should be discharged with a combination of LABA and LAMA. Here, we assess the effect of these guidelines on inhaler prescribing practices for patients admitted for COPD exacerbation. Methods We conducted a retrospective cohort study of patients with a clinical diagnosis of COPD who were admitted to Henry Ford Hospital between December 2017 and July 2024 with a diagnosis of COPD exacerbation. Patients aged 18 years or older were included in this study. The Institutional Review Board of Henry Ford Health approved the study, and the requirement for informed consent was waived. Results A total of 17,116 consecutive patients admitted with COPD listed as a problem were screened. Among these, 2,537 patients had a primary diagnosis of COPD exacerbation, with 2,139 admitted before the updated guidelines (pre-guidelines) and 224 admitted after the publication of the new guidelines (post-guidelines). Before the guidelines, 813 patients (38.01%) were discharged on double LABD, and this number significantly increased to 224 patients (56.28%) post-guidelines (p < 0.001). Double LABD prescriptions increased after the guidelines in patients admitted with no LABD (14.7% to 32.9%, p <0.001), single LABD (24.7% to 39.2%, p <0.001) and double LABD (85.32% to 94.33%, p < 0.001). Significant predictors of appropriate discharge of double LABD included post-guideline period (OR 2.57, 95% CI 1.96-3.36, p < 0.001), admission to the pulmonary service (OR 1.51 [95% CI 1.25-2.03], p<0.001), admission on a single inhaler (OR 1.73 [95% CI 1.37-2.19], p<0.001), and admission on double inhalers (OR 32.91 [95% CI 25.08-43.18], p<0.001). Conclusions Our study demonstrated that the guidelines were associated with an increased rate of discharge on double LABD after admission for COPD exacerbation. Additionally, the involvement of the pulmonary service positively affected discharge on guideline-directed therapy.
Volume
211
First Page
A6176
