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May 20, 2026

C35-16 Inhaler Prescribing Patterns for COPD Exacerbations at Emergency Department Discharge

Key Points

This study aims to evaluate inhaler prescribing patterns following emergency department encounters for COPD exacerbations.
Retrospective cohort study conducted in two emergency departments over one year.
Examined encounters of adults with COPD exacerbations discharged after receiving inhaled bronchodilators and corticosteroids.
Data extracted from electronic health records to identify prescribed maintenance inhaler regimens.
Of the encounters, 26.8% from the academic center were discordant with GOLD guidelines compared to 9.7% from the community hospital.
Majority of discharge regimens included SABA-only therapy at the academic center (32.9%) versus community (21.4%).
Higher discordance at the academic center suggests a need for better adherence to treatment guidelines.

Abstract

Abstract Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend that COPD management be tailored to a patient’s exacerbation history and symptom burden. This often requires escalation of maintenance therapy after an exacerbation. However, real-world prescribing frequently deviates from these guidelines. This study evaluated inhaler prescribing patterns following emergency department encounters for COPD exacerbations. Methods This retrospective cohort study examined COPD exacerbation encounters in two emergency departments within a single health system from March 2024 to March 2025. Adult patients discharged from the ED after receiving an inhaled bronchodilator and systemic corticosteroids with an ICD-10 diagnosis of J44.9, J44.1, J44.0, J41.0, J41.1, J41.8, J42, J43.0-J43.9, or J20 were included. Patients with a disposition other than discharge, those with asthma, those with multiple prescribed maintenance inhaler regimens, and those with missing data were excluded. Data were extracted from the institution’s EHR relational databases. The outcome of interest was the rate and type of prescribed maintenance inhaler regimens. Prescriptions of ICS-only and ICS/LABA maintenance therapy were considered GOLD guideline discordant. Results There were 226 ED encounters that met inclusion criteria; 120 (53%) occurred at the tertiary academic center and 106 (47%) at the community hospital. 23 of the academic center encounters and 22 of the community hospital encounters were excluded for multiple maintenance inhaler prescriptions with overlapping therapeutic class. From the tertiary medical center, discharge regimens included SABA-only (32.9%), ICS (3.1%), LAMA (5.2%), LABA/LAMA (19.6%), LABA/ICS (23.7%), and LABA/LAMA/ICS (15.5%). From the community hospital, discharge regimens included SABA-only (21.4%), ICS (1.2%), LAMA (7.1%), LABA/LAMA (13.1%), LABA/ICS (9.5%), and LABA/LAMA/ICS (47.6%). Figure 1. Conclusion Of the discharge regimens from the academic medical center 26.8% were discordant with GOLD recommendations compared with 9.7% from the community hospital. Additionally, 32.9% of academic discharges included SABA-only therapy versus 21.4% in the community cohort. While SABA-only regimens may be appropriate for select GOLD Group A patients (those with a single moderate exacerbation and low symptom burden), this likely reflects a higher-risk population requiring close follow up to monitor for recurrent symptoms or exacerbations and timely escalation of maintenance therapies. In future iterations, our team plans to develop and implement a clinical decision support tool to promote guideline-concordant prescribing at ED discharge and ensure appropriate outpatient follow up. This abstract is funded by: None

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