Not Enough COPD Patients Receiving Maintenance Tx, Research Suggests
A new study suggests that many patients with COPD may be undertreated (particularly with long-acting maintenance medications), despite recommended treatment guidelines. Since the publication of guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), many studies have demonstrated significant benefits of using maintenance drugs for COPD; this research sought to assess improvement, if any, in the pharmacological management of COPD since the original GOLD guidelines.
Data from 55,361 patients ≥40 years of age with a confirmed COPD diagnosis from the Truven Health MarketScan Commercial Claims and Encounters and the Medicare Supplemental Databases was reviewed from the years 2007 and 2008. The outcomes assessed were prescription claims for maintenance or reliever medication, specific medication classes, and the prevalence of oral corticosteroid (OCS) or antibiotic use for short-term treatment of an acute exacerbation of COPD after hospitalization or ED visit. Maintenance medications included inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), fixed-dose combination ICS + LABA, tiotropium (TIO), and inhaled ipratropium or fixed-dose combination ipratropium + albuterol (collectively referred to as ipratropium [IPR]). Reliever medications studied were short-acting beta-agonist (SABA), oral corticosteroid (OCS), nebulized ipratropium or combination ipratropium–albuterol (collectively referred to as nebulized ipratropium [nebIPR]), and antibiotics.
While the majority of COPD patients received either maintenance or reliever medications (74%), less than half received the guideline-recommended maintenance medications (45%). This was particularly evident in patients with an exacerbation history or those receiving short-term treatment for acute exacerbations (64%). Approximately 23% of patients experienced an acute exacerbation of COPD requiring hospitalization or ED visit. Short-term treatment with OCS or antibiotics was greater for exacerbations requiring hospitalization vs. ED visits (68% vs. 44%). The type of short-term treatment did not differ by type of exacerbation. The most common drug class for maintenance treatment was the combination of an inhaled corticosteroid and a long-acting beta-agonist, followed by tiotropium.
These results suggest that many COPD patients are still undertreated and not receiving maintenance medications. Future research should continue to evaluate patterns of pharmacotherapy in relation to recommended guidelines.
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