Students Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: The 2022 GOLD guidelines recommend reserving inhaled corticosteroids (ICS) as maintenance therapy for patients with exacerbations despite appropriate bronchodilator therapy, elevated eosinophils, or concomitant asthma. However, patients without these factors who present with suspected, but unconfirmed COPD are still commonly prescribed ICS-containing regimens as initial therapy.
Research Question or Hypothesis: What inhalers are prescribed as maintenance therapy in patients with suspected, but unconfirmed COPD?
Study Design: Retrospective cohort study
Methods: This is an IRB-approved study of adults 40 years and older admitted between January 1, 2016, and December 31, 2022. Patients without a prior COPD diagnosis who presented with a suspected COPD exacerbation or acute respiratory failure secondary to suspected COPD were included. Patients who were discharged to hospice, expired during hospitalization, or had asthma were excluded. The primary endpoint is inhaler prescribing trends on hospital discharge. Secondary endpoints, assessed within 180 days of discharge, include the proportion of patients with a confirmed COPD diagnosis, readmission rates due to COPD exacerbations, and ICS-related adverse events. Descriptive statistics were used for data analysis.
Results: Of the 15 patients admitted in 2022, 9 (60%) were female, 14 (93%) were white, and 11 (73.3%) were current smokers. Seven (46.7%) patients were prescribed inhalers on discharge, 2 (13.3%) with as needed and 5 (33.3%) with maintenance regimens. Of patients with new maintenance regimens, 3 (60%) were prescribed ICS-containing regimens. Within 180 days of discharge, 2 (13.3%) patients were formally diagnosed with COPD, 1 (6.7%) was readmitted with a COPD exacerbation, and 3 (20%) experienced ICS-related adverse events.
Conclusion: This study demonstrates overall low maintenance therapy prescribing in patients with suspected, but unconfirmed COPD. However, among patients prescribed maintenance therapy, ICS-containing regimens were common. While generalizability is currently limited by sample size, continued data collection for patients admitted between 2016-2021 will provide further insight into prescribing trends.
Presenting Author
Madison Owen PharmD CandidateAtrium Health Wake Forest Baptist Medical Center
Authors
Erica Anderson PharmD
Atrium Health Wake Forest Baptist Medical Center
Danielle Harrison PharmD Candidate
Atrium Health Wake Forest Baptist Medical Center
Alexandra Mihm PharmD
Wingate University
Alexandria Wingler PharmD Candidate
Wingate University