Inhaler Utilization in Advanced COPD

Abstract

SESSION TITLE: Safety and Effectiveness of COPD Treatments SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 25, 2016 at 11:00 AM - 12:15 PM PURPOSE: Inhaled Corticosteroids (ICS), Long-acting Beta Agonists (LABA ) and Long Acting Muscarinic Antagonists (LAMA) are often used as controllers to relieve symptoms of dyspnea and coughing in advanced COPD. However, due to expense and refractory symptoms, compliance can be poor. We characterized controller (C) and rescue (R) canister consumption as well as oral corticosteroid (OCS) and antibiotic (ABX) use in patients with advanced COPD. METHODS: All Pulmonary Function Tests (PFTs) performed at a single center from 2011-2012 were reviewed, and patients with FEV1 less than 50% were studied. PFTs were reviewed for bronchodilator responsiveness (BDR), air trapping (AT) and emphyema (EM). All purchases of CC, RC, OCS and ABX from 2012-15 were recorded. Data was recorded on an Excel Spreadsheet. RESULTS: 185 patients were identified. Median FEV1 was 40% (range 11-50). Median age was 69 (range 37-91), 52% were male, 38% had BDR, 39% had AT, and 15% had EM. Twenty-four (13%) actively smoked and 30 patients died. Patients used a median of 0.25 controllers/month (C/m) (range 0-6). BDR patients used a median 0.33 C/m, and non-BDR patients used 0.16 C/m (p=0.17) . EM patients used 0.23 C/m and non-EM used 0.26 C/m. AT patients used 0.26 C/m and non-AT used 0.20 C/m. None of these differences were statistically significant, although the BDR patients trended towards significance. Patients used 0.7 rescue canisters/month. This figure did not differ between BD, AT and EM subgroups. Over 4 years, patients received a median of 5R canisters, 17 days of ABX and 22 of OCS. Forty-one patients (22%) never purchased a single C and 31 (16%) required no ABX or OCS. Fourteen (7%) patients used 1 or more C/m. Their median age was 65, and median FEV1 was 32%. Eight of these 14 (57%) had AT, 4/14 (29%) has BDR, and 1/14 (7%) had EM. Two (14%) actively smoked. These patients used a median of 19 R, 21 days of ABX and 63 of OCS. These were not different compared to non-compliant patients. CONCLUSIONS: Very few patients with advanced COPD purchased enough C for daily use. Patients who used controllers on a daily basis were similar to non-compliant patients, and had similar or more use of R, ABX and OCS compared to less compliant patients. No specific PFT subgroup was more compliant with C. CLINICAL IMPLICATIONS: Very few patients with COPD comply fully with C, and unless they report significant symptoms relief, a rigorous focus on adherence may not be appropriate and may be misguided. This has cost implications for patients and health care systems. DISCLOSURE: The following authors have nothing to disclose: Andrew Matthys, Morgan Gilani, David Witt, Sridhar Prasad No Product/Research Disclosure Information