Assessing inpatient formulary-driven inhaler use in presumed Group B chronic obstructive pulmonary disease

Background

Long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist (LABA) combination maintenance therapy is recommended for patients with Group B chronic obstructive pulmonary disease (COPD) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Exposure to inhaled corticosteroids (ICS) in these patients may increase adverse effects without adding clinical benefit. Inpatient formulary limitations may facilitate unnecessary exposure to ICS and ICS-associated adverse events while hindering the use of optimal LAMA/LABA inhaler therapy in Group B COPD patients.

Objectives

The main objectives of this project were to evaluate the appropriateness of inpatient prescribing of ICS products in patients with presumed Group B COPD and to determine the incidence of ICS-associated adverse events when used in this patient population.

Methods

This single-center retrospective cohort study used EPIC electronic health record data to capture patients 18 years and older diagnosed with COPD, classified as presumed GOLD Group B, who had an admission medication reconciliation completed between July 26, 2022 and September 20, 2023. Patients were excluded if they were adherent to ICS prior to admission, currently or had been admitted for a COPD exacerbation, diagnosed with asthma, or had never received a pharmacist medication reconciliation. Descriptive statistics were utilized to assess all objectives.

Results

Our study included 100 patients with presumed Group B COPD. We showed that 14% of the patients assessed (n = 14) were given ICS therapy against GOLD criteria. Additionally, we identified that 14% of these patients (n = 2) experienced potential ICS-associated pneumonia during their inpatient stay.

Conclusion

Assessment of inappropriate ICS use at an institution without a lone LABA or LAMA/LABA inhaler on formulary showed that inhaler availability may contribute to the risk of presumed GOLD Group B patients receiving inappropriate ICS therapy.