Obstructive Lung Diseases: Safety and Effectiveness of COPD Treatments |

Improved COPD Control With Combination LABA/CS Using Small Volume Nebulized Delivery FREE TO VIEW

Lydia Winnicka, MD; Jamie Molina, MD; Crystal Duran, MD; Charumathi Raghu Subramanian, MD
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Guthrie Clinic, Sayre, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):924A. doi:10.1016/j.chest.2016.08.1024
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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: There is a growing body of research supporting initiating long-acting β-agonist (LABA) therapy via small volume nebulization (SVN) in patients with uncontrolled COPD. Arformoterol SVN compared to a placebo has previously demonstrated a 40% lower risk of respiratory death or COPD-related hospitalization over 1 year, improvements in trough FEV1 and FVC, and improved quality of life via the St. George’s Hospital Respiratory Questionnaire and Clinical COPD Questionnaire.1 Arformoterol SVN has also shown to be superior as compared to short-acting β-agonist (SABA) SVN in preventing readmissions after hospitalization for COPD exacerbation.2 In patients with uncontrolled COPD, despite regular use of a combination LABA/corticosteroid (CS) inhaler, changing the medication delivery system to an SVN formulation is an option for better disease control. Hypothesized reasons for improved disease control with SVN formulations include ease of use and improved medication delivery. There is currently no data comparing inhaled LABA/CS versus the same medication via SVN.

METHODS: This retrospective cohort study used the electronic health record (EHR) to identify patients who were newly implemented on arformoterol/budesonide SVN between September 2014 and January 2016. For a time period of 3 months pre- and post-initiation, number of emergency room (ER) visits and hospital admissions for COPD exacerbation and days of systemic steroids related to COPD exacerbation was tallied and multivariate analysis was performed. Inclusion criteria included Medicare-insured patients, diagnosis of severe COPD based on pulmonary function testing using GOLD classification, age >50 years, previous use of inhaled LABA/CS combination, and documented failure of said therapy. Exclusion criteria included patients on chronic steroids and with a diagnosis of asthma.

RESULTS: A total of 23 patients were included in the study. Out of 46 patients identified to have been implemented on arformoterol/budesonide SVN, 23 patients were excluded due to non-compliance or lack of follow-up evaluations. There was a significant decrease in combined ER visits and hospitalizations after arformoterol/budesonide SVN initiation, 0.99 with inhaled LABA/CS and 0.22 with arformoterol/budesonide SVN (p=0.002). There was also a decrease in the number of days of systemic steroids after arformoterol/budesonide SVN initiation, 8.78 with inhaled LABA/CS and 4.09 with arformoterol/budesonide SVN, though this was not statistically significant (p=0.095).

CONCLUSIONS: This study suggests that patients with uncontrolled, severe COPD, despite regular use of LABA/CS via a handheld inhaler, may benefit from switching to the same medication via SVN delivery system. This can lead to a decrease in ER visits and hospitalizations related to COPD exacerbation. Prospective studies could confirm decreases in health-care utilization related to COPD exacerbations as well as improved patient outcome after initiation of arformoterol/budesonide SVN.

CLINICAL IMPLICATIONS: Frequent COPD exacerbations represent a significany burden to both patients and the healthcare system. Not only could patient outcomes improve with LABA/CS SVN, but the economic strain to hospitals from insurance-imposed penalties for readmissions may be lessened.

DISCLOSURE: The following authors have nothing to disclose: Lydia Winnicka, Jamie Molina, Crystal Duran, Charumathi Raghu Subramanian

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