Health Systems May Not Be Following COPD 2017 Guidelines

A poster presentation at the ASHP Midyear Meeting 2017 found that health systems are not completely following the 2017 GOLD guidelines for chronic obstructive pulmonary disease (COPD) with mometasone oral inhalers.

“COPD is a chronic disease that is currently the fourth leading cause of death in the world,” Megan K Ziegler, PharmD, a pharmacist at the Sheridan Veterans Affairs Medical Center in Wyoming, wrote in her presentation. “Pulmonary function tests are required for diagnosis. The 2017 Global Initiative for Chronic Lung Disease (GOLD) guideline recommends that inhaled corticosteroids be used in Grade C or D in combination with a long-acting beta agonist or as part of a triple combination with a long-acting beta agonist and a long-acting antimuscarinic antagonist.”

In order to study how health systems within the VA are adhering to 2017 GOLD guidelines, the researchers conducted a medication use evaluation on utilization of mometasone oral inhalers in patients with COPD.

The researchers studied 121 charts of patients receiving treatment with a mometasone oral inhaler between March and December 2016 at a single VA medical center. Among these patients, 62 were diagnosed with COPD. Electronic medical records were examined to determine diagnosis, pulmonary function tests results, mometasone dose and directions, initial mometasone administration date, additional COPD medications, number of hospitalizations in last year, number exacerbations in last year, and COPD assessment tests. Medication use was compared to the 2017 GOLD guidelines to determine adherence.

Study results showed that only 34 of the 62 patients with COPD had undergone pulmonary function testing. Furthermore, only 11 of the 34 were appropriate candidates for mometasone oral inhalers based on guideline recommendations.

“Mometasone oral inhaler for COPD use within the health care system was not following the 2017 GOLD guidelines,” Dr Ziegler wrote.

As a result, Dr Ziegler and colleagues educated providers and created a clinical reminder for primary care nurses treating patients with COPD.

“Providers were educated on COPD guidelines, utilizing long-acting beta agonists and long-acting antimuscarinic antagonists as first line therapy, importance of a yearly COPD assessment, and ensuring pulmonary function tests s are documented in the Computerized Patient Record System,” she concluded. “Based on the results of the MUE, a CAT Clinical Reminder was developed for Primary Care Nursing staff to perform annually for all COPD patients.”

—David Costill

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