Differences in COPD management across clinician type: Maintenance treatment habits and patient characteristics among US pulmonologists, internal/family medicine physicians, nurse practitioners, and physician assistants.

Abstract

ObjectivesTreatment recommendations for chronic obstructive pulmonary disease (COPD) are based on single or combination long-acting bronchodilator therapy (β₂-agonists [LABAs] or muscarinic receptor antagonists [LAMAs]), with inhaled corticosteroids (ICS) for those at risk of exacerbations. This study evaluated differences in patient characteristics and treatment patterns among US clinicians.MethodsMedical record data for patients with COPD were abstracted via a retrospective cross-sectional survey by pulmonologists, internal/family medicine physicians, nurse practitioners (NPs) and physician assistants (PAs).ResultsData on 700 patients were collected from 175 clinicians: 100 pulmonologists, 45 internal/family medicine physicians, 30 NP/PAs. Respondents classified patients as having Mild (11%), Moderate (51%), or Severe/Very Severe (38%) COPD, with highest perceived disease burden for patients with Severe/Very Severe COPD. Dual therapies were prescribed differently according to clinician type. Internal/family medicine physicians and NP/PAs prescribed LABA/ICS to a significantly higher proportion of patients than pulmonologists, who favored use of dual bronchodilator therapy. Regardless of clinician type, COPD management was complex, with patients starting and transitioning to multiple treatments throughout their care.ConclusionDifferences in COPD treatment patterns exist across US clinicians. Despite current maintenance treatment, COPD had a profound impact on patients, indicating a need for improved therapies for COPD.