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 N.
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 - Rennard, Stephen I.
N1 - Funding Information:
Supported by National Institutes of Health (NIH) grants R01HL125432-01A1 (M.B.D.) and T32HL007106-41 (S.G.). The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) was supported by contracts from the NIH/National Heart, Lung, and Blood Institute (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C), supplemented by contributions made through the Foundation for the National Institutes of Health and the 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; and Sunovion.
Publisher Copyright:
Copyright © 2019 by the American Thoracic Society.
PY - 2019/2
Y1 - 2019/2
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 -