Encore Presentations
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Background
Current guideline recommendations for chronic obstructive pulmonary disease (COPD) state that inhaled corticosteroids (ICS) have benefit in patients with elevated eosinophil counts and a history of hospitalizations. Historical evidence has shown a significantly increased risk of pneumonia with any regimen containing an inhaled corticosteroid in COPD patients; therefore, stewardship of these medications is critical to prevent adverse outcomes in this patient population. The purpose of this study was to characterize the appropriateness of inhaled corticosteroid prescription at hospital discharge in patients admitted for a COPD exacerbation.
Methodology
The institutional review board approved this single-center, retrospective study conducted using the electronic health record of a large, academic medical center. Inclusion criteria were patients at least 40-years-old admitted from January 1, 2021 to December 31, 2021 for an acute exacerbation of COPD (AECOPD), or patients with a diagnosis of pneumonia and a documented history of COPD. Exclusion criteria were patients less than 40-years-old, having a concurrent asthma diagnosis, death prior to discharge, hospital exit against medical advice, discharged to hospice, history of tracheotomy, active lung cancer, interstitial lung disease, or pulmonary vasculitis. The primary endpoint was the proportion of patients prescribed guideline-concordant inhaled corticosteroid treatment at hospital discharge following hospitalization for an AECOPD. Secondary endpoints included the proportion of patients receiving guideline-concordant inhaled pharmacotherapy at discharge, the proportion of current smokers with documented smoking cessation counseling during hospitalization and pharmacotherapy prescribed at discharge, and rates of 30-day readmission related to ICS use. Statistical analysis involved the use of chi-square values for categorical data and t-tests for comparison of means.
Results
200 patients met criteria for inclusion into the study. Acute fluctuations in eosinophil counts were seen throughout the duration of hospitalization. 134 patients were prescribed inhaled corticosteroids at hospital discharge, with 41% of these patients determined as receiving guideline-concordant inhaled corticosteroids. 33% of 30-day hospitalizations for patients prescribed inhaled corticosteroids were for pneumonia. 34% of patients were deemed to have a guideline-concordant inhaled pharmacotherapy regimen at discharge. Of the 113 current smokers included in the study, 65.5% had documented smoking cessation counseling during hospitalization, with 6.2% receiving smoking cessation pharmacotherapy at discharge.
Conclusions
Further guidance is needed to determine the appropriateness of inhaled corticosteroid prescription at hospital discharge given the acute fluctuations in eosinophil counts that were seen in this inpatient analysis. This study confirms the associated risk of prescribing inhaled corticosteroids and the incidence of pneumonia. Smoking cessation for COPD patients remains a key area of optimization in the inpatient setting.
Presenting Author
Luke Hentrich PharmDThe University of Tennessee Medical Center
Authors
Katherine Kite PharmD Candidate
University of Tennessee Health Science Center
Andrea S. Franks PharmD, BCPS
University of Tennessee Health Science Center, College of Pharmacy
Jason Green DO
University of Tennessee Medical Center
Hannah Denham PharmD, BCPS
Univeristy of Tennessee Medical Center
Danielle Dennis PharmD, BCPS
University of Tennessee Medical Center