Abstract Rationale Chronic Obstructive Pulmonary Disease (COPD) is responsible for substantial health and financial burden in the United States and globally and is punctuated by periods of exacerbations. In 2022, 11.7 million people or approximately 4.6% of adults in the US reported a diagnosis of COPD. With 138,825 deaths in 2021, COPD was the 5th leading cause of death. 1,2,3 An estimated 31.3 billion dollars were spent on COPD in 2019,4 and 50-70% of these costs were related to exacerbations requiring hospitalization and nearly 50% are dead at two years.5,6Inhaled maintenance therapy with corticosteroids/long-acting β2-agonists/long-acting muscarinic antagonists (ICS/LABA/LAMA) for COPD patients with severe exacerbations can significantly decrease exacerbation rate, healthcare expenditures, and all-cause mortality. 7,8,9 The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommends initial use of triple therapy for COPD patients with history of any severe exacerbation.10,11 In addition, tobacco cessation has been shown to significantly reduce frequency and severity of COPD exacerbations,12 and lung cancer screening in eligible patients can reduce mortality by 20%.13We undertook this study of patients hospitalized with COPD exacerbations in an academic hospital in South Carolina to assess the implementation of evidence based treatments for this disease Methods COPD exacerbations were identified through EPIC patient lists of discharged patients with a primary diagnosis of COPD or a primary diagnosis of respiratory failure with a secondary diagnosis of COPD from July 2025-October 2025, followed by manual chart review. Demographics extracted included gender, race, insurance, tobacco use status and history of lung cancer screening. Outcomes assessed included whether patient had a pulmonary consult while inpatient, a pulmonary follow up appointment, or triple therapy prescribed at discharge. Results Of 75 patients identified with primary and secondary COPD diagnosis, 29 patients were confirmed with manual chart review (table 1). Half were discharged without pulmonary follow up, with lower rates of referral for men, active tobacco users, and AA race (RR 0.63, 0.71, and 0.82 respectively). Less than 45% of patients were discharged with triple therapy inhalers, with women, AA race and active tobacco users being more likely to receive prescriptions (RR 1.18, 1.9, 1.3 respectively). Conclusions Patients hospitalized for severe COPD exacerbations represent a high-risk group that are often eligible for interventions with potential to decrease exacerbation rates, mortality, and healthcare expenditures. This data showing low rates of appropriate inhaler prescription and referral to pulmonary specialists at discharge demonstrate an unrealized opportunity to improve patient healthcare outcomes This abstract is funded by: None
J Lozier (2026) studied this question.