Abstract Rationale The 2024 and 2025 GOLD recommendations categorize patients’ symptomatology by dyspnea (mMRC) and frequency of exacerbations, which dictate choice of therapy. The American College of CHEST Physicians recommends pulmonary rehabilitation for patients with moderate-very severe COPD with exacerbation ≤ 4 weeks of hospitalization. Our study evaluates current practice alignment in COPD care after admission with GOLD and CHEST guidelines. Methods Patients admitted with COPD exacerbation in November 2024 to two hospitals (GWV and GCMC) aged ≥ 18 and documented mMRC. Charts reviewed for medication use within the year after discharge (LABA; ICS, LAMA; dupilumab; chronic azithromycin; roflumilast; and ensifentrine), pulmonary rehab referral or bronchoscopic lung volume reduction (BLVR), and mortality and readmission within 1 year and patients that had low dyspnea (LoDys, mMRC ≤ 1) and high dyspnea (HiDys, mMRC ≥ 2). A two-sample t-test was used to calculate the differences between the means, and a two-proportion z-test was used to evaluate the differences between the two proportions, both calculated with a 95% confidence interval. Results 126 patients with GOLD-E COPD were reviewed, and only 82 had a mMRC for categorization of LoDys or HiDys. Average age was 69.6± 11.9 years and 39.7% were male (n = 50). 7.93% were smoking during the study period. In LoDys versus HiDys, similar %males (34.5% versus 32.1%, p = 0.825) and age (71.3±9.24 vs. 69.1±12.4, p = 0.366). Increased current smokers in HiDys group (11.3% versus 0%, p = 0.009). Similar LABA use (62.1 vs. 75.5, p = 0.214), chronic azithro (6.9% vs. 7.5%, p = 0.913), roflumilast (10.3% vs. 17.0%, p0.386), and encifentrine (6.9 vs. 11.3%, p = 0.490). One year admission-free survival was similar, although trended towards greater admission-free survival in LoDys (55.17% vs. 34%, p = 0.060). LAMA noted lower in the LoDys (62.1% vs. 90.6%, p = 0.004). Lower rate of referral to pulmonary rehab in LoDys (6.9% vs. 60.4%, p = 0.00), but BLVR referral rates were higher in the LoDys group (3.4% vs. 0%, p = 0.034). Conclusion Our study examines real-world data across multiple clinics in rural Northeastern Pennsylvania. Our cohort includes GOLD-E, and should all be on LAMA and LABA. Noted greater prescription of LAMA in HiDys. GOLD recommends ensifentrine for persistent dyspnea on LABA/LAMA, but utilization of encifentine is low. Cohorts should be referred for pulmonary rehab, but HiDys referred to pulmonary rehab more frequently. Further studies are needed to determine whether simple education or a strategic approach to increase access to medications and rehabilitation can promote greater alignment of clinical care to current guidelines. This abstract is funded by: None
Santi et al. (Fri,) studied this question.