Temporal trends in dual bronchodilator prescribing before and after GOLD 2023 publication

Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization and readmission. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report recommends dual long-acting bronchodilator (LABD) therapy consisting of combined long-acting beta agonist (LABA) and long-acting muscarinic antagonist (LAMA) therapy following hospitalization for COPD exacerbation. We evaluated temporal trends in dual LABD prescribing before and after publication of the GOLD 2023 recommendations.

We performed a retrospective cohort study of 2,537 patients hospitalized with COPD exacerbation at Henry Ford Hospital between December 2017 and July 2024. Patients were categorized into pre-guideline (December 2017-April 2023) and post-guideline (May 2023-July 2024) periods. The primary outcome was the discharge prescribing of dual LABD therapy.

Discharge prescribing of dual LABD therapy was higher in the post-guideline period compared with the pre-guideline period (56.3% vs. 38.0%, P<0.001). Temporal trend analysis demonstrated that prescribing rates were already increasing prior to publication of the GOLD 2023 report, with continued increases observed afterward. Differences between periods were most pronounced among patients not previously receiving dual LABD therapy. In multivariable analysis adjusted for age and Charlson comorbidity score, post-guideline admission period [odds ratio (OR) 2.43, 95% confidence interval (CI): 1.85-3.20, P<0.001], pulmonary service admission (OR 1.57, 95% CI: 1.21-2.03, P=0.001), and pre-admission inhaler regimen were independently associated with discharge on dual LABD therapy.

Discharge prescribing of dual LABD therapy increased over the study period and remained higher following publication of the GOLD 2023 recommendations. Temporal trend analysis suggested that prescribing patterns were already evolving prior to formal guideline publication, likely reflecting increasing incorporation of emerging evidence into clinical practice. Further studies are needed to evaluate longer-term prescribing trends and associated clinical outcomes.