Adherence to Inhaled Medication Guidelines in Patients with COPD: Evaluating the GOLD 2023 Strategy in a Real-World...

Area of Science:

• Pulmonology
• Clinical Practice Guidelines
• Pharmacotherapy

Background:

• The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy updated inhaled medication recommendations, restricting long-acting beta-agonist/inhaled corticosteroid (LABA/ICS) use and emphasizing ICS for exacerbations.
• These changes necessitate evaluating clinician adherence and prescribing patterns in real-world settings.

Purpose of the Study:

• To assess adherence to the 2023 GOLD strategy for inhaled therapies in a chronic obstructive pulmonary disease (COPD) cohort.
• To identify changes in prescribing patterns following the 2023 GOLD strategy update.
• To investigate the prevalence and indications of inhaled corticosteroid (ICS) use.

Main Methods:

• A real-world cohort of COPD patients was evaluated in 2022 and reassessed in 2023 at a Dutch teaching hospital.
• Treatment adherence was determined by comparing patient prescriptions against the applicable GOLD strategy for each year.
• Specific focus was placed on ICS prescription patterns and their alignment with guideline criteria.

Main Results:

• Guideline adherence increased slightly from 51.6% in 2022 to 57.3% in 2023.
• Patients with low eosinophils, no exacerbations, or less severe COPD were less likely to receive guideline-adherent treatment in 2023.
• Overtreatment with ICS was prevalent, affecting 25.4% of patients.

Conclusions:

• A significant portion of COPD patients are not treated according to current GOLD recommendations, indicating a gap between guidelines and practice.
• While reasons for deviation may exist, physicians should critically evaluate treatment optimality, especially concerning ICS use.
• Barriers to implementing the GOLD strategy require identification and discussion to improve COPD management.