Adherence to the Canadian Thoracic Society Chronic Obstructive Pulmonary Disease Pharmacotherapy Guidelines in a real-world hospital setting

Abstract

RATIONALE The Canadian Thoracic Society (CTS) publishes chronic obstructive pulmonary disease (COPD) guidelines with recommendations regarding which inhaled pharmacotherapy to prescribe. A minimal amount is known about the implementation of these guidelines in routine clinical practice. OBJECTIVES The main goals of this review were to assess the adherence to the CTS COPD pharmacotherapy guidelines in a real-world setting of patients with a severe exacerbation, to determine predictors of increased guidelines adoption, and to review if subjects leaving the hospital without recommended inhaled therapy had a higher rate of readmission for COPD within 30 days. METHODS Patients treated in 2022 at Montfort Hospital for a COPD exacerbation (hospitalization or emergency department) were reviewed. Medication lists at the time of presentation and discharge were charted in addition to patient clinical characteristics and COPD admissions up to 30 days after the initial assessment. A comparison of COPD patients with and without recommended inhaled therapy optimization was performed. MEASUREMENTS AND MAIN RESULTS A total of 214 patients were admitted for a COPD exacerbation. From this sample, 111 were candidates for review of their inhaled therapy as per the CTS guidelines; however, only 22 (20%) received recommended optimization. Subjects who were admitted to inpatient units and those with spirometry results on file were more likely to receive appropriate pharmacotherapy at discharge (both p = 0.02). Patients not optimized as per the guidelines were at higher risk of readmission for a COPD exacerbation within 30 days (p = 0.02). CONCLUSIONS Adherence to the CTS COPD pharmacotherapy guidelines was low in a real-world hospital setting. Interventions that would help increase their adoption would result in improved patient outcomes.