Disease Management Opportunities for Chronic Obstructive Pulmonary Disease: Gaps Between Guidelines and Current Practice

Abstract

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with broad economic impacts. It presents a major opportunity for healthcare cost reduction and improved functional status. This study measures the gaps between current treatment practices and recently issued guidelines, and identifies the primary opportunities for COPD disease management. COPD patients (n = 1,036) were initially identified using pharmacy claims data on outpatient respiratory medication use. Through a health assessment survey, they confirmed their diagnosis and reported on their medical resource use, vaccinations, smoking, and health-related quality of life (QOL). Drug utilization was measured using a 12-month retrospective review of prescription claims. Patients were stratified by severity level based on QOL scores. A large subset of patients (25.7%) did not use inhaled bronchodilators, the preferred first-line therapy in COPD guidelines; instead, these patients used oral bronchodilators (8.1%) or no bronchodilator at all (17.6%). Inhaled corticosteroids (ICSs) were used by 54.8% of patients. Many patients had not received an influenza vaccination during the previous year (20.7%) or a pneumococcal vaccination during their lifetime (28.3%). Some patients continue to smoke on a regular basis (11.8%). A majority of patients reported that they do not feel knowledgeable about their disease (52.2%) or therapy (53.2%). In summary, significant gaps exist between COPD treatment guidelines and clinical practice, including underuse of inhaled bronchodilators, extensive use of ICSs, and underuse of vaccinations. To reduce the condition's clinical and economic impacts, COPD disease management programs need to target four key areas: pharmacotherapy, vaccination rates, smoking cessation, and patient education.