Abstract Rationale People living with chronic obstructive pulmonary disease (COPD) have a high medication burden, which in turn is associated with worse patient outcomes. Deprescribing, defined as the purposeful discontinuation or reduction of medications, is important in COPD due to polypharmacy risk and older adult comorbidities, and is supported by patients, patient caregivers, and clinicians. We conducted a qualitative study to better understand barriers and facilitators to deprescribing among primary care and pulmonology clinicians to inform future deprescribing interventions for people with COPD. Methods We recruited an interdisciplinary sample of primary care (PC) and pulmonology clinicians who care for patients with COPD in a tertiary health system and conducted one-on-one semi-structured Zoom interviews between July and October 2025 to examine perceived barriers and facilitators to deprescribing in COPD . We used thematic analysis to identify salient themes. Results Fifteen providers completed interviews, seven PC clinicians: 3 physicians, 2 pharmacists, 2 nurse practitioners (NPs), and eight from pulmonary: 5 physicians, one NP, one physician assistant, and one respiratory therapist. Participants averaged 45 years old (range 34-68); 8 (53%) were female, 4 (27%) were Black or Asian race. Average years in practice was 11.7 (range 1-42). Deprescribing facilitators were: 1) Addressing multiple symptoms with one medication: “We like switching them to a lot of things that can kill two birds with one stone.” 2) Cost/formulary changes: “Medicare, they do a lot of changes⋯that does prompts change of medication for affordability and coverage purposes.” 3) Clinical response: “if their symptoms have been well controlled, if they haven’t had exacerbations, then we’ll try and step down their inhalers.” 4) Perceived harm/risk of medications: “Klonopin for sleep for 35 years⋯you have severe lung disease and you’re probably aspirating. So we need to try and figure out if there’s a safer medication for you to take.” Barriers included: 1) Perceived medication necessity by patients: “But you gave me this medication. I need this medication. No, I’m telling you, you might not need this medication.” 2) Communication across health systems: “Our systems don’t talk.” 3) Limited time with patients: “time and I guess attention to that task. COPD is unique in that their medications are not all just pills.” Additional quotes are in Table 1. Conclusions Barriers and facilitators to deprescribing include patient-level factors, medication characteristics, and health system/insurance barriers. These findings can inform the design of targeted multi-component interventions to improve medication safety in COPD. This abstract is funded by: NHLBI K23 HL159239
Mcdermott et al. (Fri,) studied this question.