Abstract Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD) groups patients into Groups A, B and E based on symptoms and exacerbations. The guidelines recommend inhaler therapy based on GOLD grouping. Current recommendations include a single bronchodilator for those in Group A, a combination bronchodilator (LABA and LAMA) in group B and a combination bronchodilator (LABA and LAMA) in group E except for those with peripheral eosinophilia 300 cells/μL who would qualify for triple therapy (LABA, LAMA and ICS). We sought to investigate the adherence to GOLD guidelines in inhaler prescribing practices among internists and pulmonologists at our institution. Methods This study is being conducted at the University of Florida - Jacksonville and is actively enrolling patients. The COPD Cohort comprises patients with spirometry confirmed COPD (FEV1/FVC0.7) managed by internists and pulmonologists at the institution. Institutional review board approval was obtained, and patient informed consent was waived for this study. For each patient in this cohort, we collected demographic and spirometric data, COPD Assessment Test scores, peripheral eosinophilia and number of COPD exacerbations to group patients into GOLD groups A, B and E. We then compared the current prescribed inhaler for each subject with those recommended by GOLD guidelines and calculated adherence rates. Results We collected data from a total of 140 patients. The average age was 65.8 years. 51% were female. 70% were identified as Caucasian followed by 26% as Black or African American. Medicare beneficiaries comprised 57% of the study population. Current smokers accounted for 33% of our cohort and the most common comorbidity was hypertension (76%) followed by hyperlipidemia (62%) and 24% of patients had co-existing bronchiectasis. Of the cohort, 24% were classified as GOLD Group A, 31% as Group B, and 45% as Group E. Of these, 88% of patients grouped into GOLD A were adherent to inhaler therapy as outlined by the GOLD 2024 guidelines, 70% in GOLD B and 68% in GOLD E. Conclusion Based on our study, the overall average adherence rate to GOLD guidelines for inhaler prescribing was 75% across all groups. It must be noted that insurance coverage and other factors including provider awareness to guidelines often influence inhaler selection, impacting adherence to GOLD guidelines. Improved policies ensuring access to guideline-recommended therapies and greater emphasis on evidence-based prescribing among providers are needed. This abstract is funded by: None
Boppana et al. (Fri,) studied this question.