“COPD: Filling In The Gaps” Resource Toolkit
The references here are provided as resources to support the presentation "COPD: Filling In The Gaps", presented to state chapters of organizations for family practice, nurse practitioners, and PAs. An archived recording of the presentation is included below.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2022 Report [PDF]
The GOLD strategy document for the diagnosis, management and prevention of COPD, along with the corresponding pocket guide, are developed for healthcare professionals based on the best scientific information available. This global evidence based document is used as a tool to implement effective management programs based on local healthcare systems around the world. Each year the GOLD Science committee updates the GOLD report based on a standard scientific review process conducted twice a year.

You may download a free PDF of the 2022 GOLD Report here. (It's big, so please be patient as it downloads.)

Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease
Patients with chronic obstructive pulmonary disease (COPD) often present with severe acute exacerbations requiring hospital treatment. However, little is known about the prognostic consequences of these exacerbations. A study was undertaken to investigate whether severe acute exacerbations of COPD exert a direct effect on mortality. This study shows for the first time that severe acute exacerbations of COPD have an independent negative impact on patient prognosis. Mortality increases with the frequency of severe exacerbations, particularly if these require admission to hospital. Read more here.

The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present this overview of the management of patients with COPD during the COVID-19 pandemic.

Prescription of inhalers in asthma and COPD: Towards a rational, rapid and effective approach
The correct use of inhalers is not granted and patients often incur in many mistakes when using pMDIs and DPIs, despite repeated instructions. A better matching between patient and device could be accomplished if the physician is aware of: (1) the patient characteristics (disease, severity, fluctuation in airflow obstruction, etc); (2) what class of medication is indicated; (3) where in the lung the medication should be delivered; and, (4) how this can be best achieved by a given device in this specific patient. 

The authors propose an evidence based approach enabling the caregiver to make a rational choice in only a few minutes by just considering the following four simple questions: Who?, What? Where? and How? (the so-called 3W–H approach).

Optimising Inhaled Pharmacotherapy for Elderly Patients with Chronic Obstructive Pulmonary Disease: The Importance of Delivery Devices
Several new inhalers have recently been launched, each with their own particularities, advantages and disadvantages. Consequently, broader availability of new drug–device combinations will increase prescription opportunities. Despite this, however, there is limited guidance available in published guidelines on the choice of inhalers, and still less consideration is given to elderly patients with COPD.

The aim of this article is to provide a guide for healthcare professionals on device selection and factors to be considered for effective inhaled drug delivery in elderly COPD patients, including device factors (device type and complexity of use), patient factors (inspiratory capabilities, manual dexterity and hand strength, cognitive ability, co-morbidities) and considerations for healthcare professionals (proper education of patients in device use).

The effects of single inhaler triple therapy vs single inhaler dual therapy or separate triple therapy for the management of chronic obstructive pulmonary disease
This study aims to compare the effects of single inhaler triple therapy comprised of inhaled corticosteroids (ICSs), long-acting β 2-agonists (LABAs), and long-acting muscarinic receptor antagonists (LAMAs) with dual therapies comprised of either LABA/LAMA, ICS/LABA or separate ICS/LABA plus LAMA triple therapy. The current meta-analysis indicated that the use of single inhaler triple therapy for COPD patients can result in a lower rate of moderate or severe exacerbations of COPD, as well as improved lung function and quality of life compared with LABA/LAMA or ICS/LABA dual therapy.

Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD
Triple fixed-dose regimens of an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA) for chronic obstructive pulmonary disease (COPD) have been studied at single dose levels of inhaled glucocorticoid, but studies at two dose levels are lacking. The authors conclude that triple therapy with twice-daily budesonide (at either the 160-μg or 320-μg dose), glycopyrrolate, and formoterol resulted in a lower rate of moderate or severe COPD exacerbations than glycopyrrolate–formoterol or budesonide–formoterol. 

Nonadherence in chronic obstructive pulmonary disease patients: what do we know and what should we do next?
Although nonadherence research in patients with chronic obstructive pulmonary disease (COPD) lags well behind other diseases, new evidence helps inform understanding about the degree and underlying causes of patient nonadherence, interventions that can improve adherence, and areas of research needed to further progress in improving this problem in patients with COPD.

Lessons learned from the research outside of COPD and a small number of COPD studies suggest that a collaborative care approach will likely provide the most potential for improving overall care, including management of depression and enhancement of adherence. 

Characteristics of patients with COPD newly prescribed a long-acting bronchodilator: a retrospective cohort study
This study aimed to characterize patients with chronic obstructive pulmonary disease (COPD) newly prescribed a long-acting bronchodilator (LABD), and to assess changes in medication over 24 months. Adherence to newly initiated LAMA monotherapy was low, with one in four patients adding to or switching from LAMA and many patients discontinuing therapy. Adherence to LABA was also low. These results suggest that additional medication to a single LABD may be required in some patients with COPD to achieve optimal disease control.

Impact of Nonadherence to Inhaled Corticosteroid/LABA Therapy on COPD Exacerbation Rates and Healthcare Costs in a Commercially Insured US Population
During the study period, 13,657 eligible patients with COPD initiated inhaled corticosteroid/LABA; of these, only 1898 (13.9%) patients were adherent during follow-up. Patients adhered to their inhaled corticosteroid/LABA treatments had lower COPD exacerbation rates and lower healthcare costs compared with the moderately and highly nonadherent patients. Better adherence to maintenance therapies may help to reduce the clinical and economic burdens of COPD. More here.

Medication adherence and persistence in chronic obstructive pulmonary disease patients receiving triple therapy
This longitudinal, retrospective cohort study of patients with COPD describes baseline characteristics, adherence, and persistence following initiation of inhaled corticosteroids (ICS)/long-acting β2-agonists (LABA)/long-acting muscarinic antagonists (LAMA) from multiple inhaler triple therapy (MITT). Patients with COPD had low adherence to and persistence with MITT in a real-world setting. Reducing the number of inhalers may improve overall adherence to intended triple therapy. More here.

Long-acting bronchodilator use after hospitalization for COPD: an observational study of health insurance claims data
The primary objective of this study was to examine LABD prescription fills after a COPD-related hospitalization. A significant proportion of COPD patients in this study did not fill an LABD prescription before hospitalization for COPD. Moreover, hospitalization did not appear to greatly impact LABD initiation. Lastly, patients who did not fill an LABD prescription within the first 90 days posthospitalization were not likely to fill an LABD prescription later. Taken together, the results of this study suggest that many patients with COPD are undertreated.

Objective Assessment of Adherence to Inhalers by Patients with Chronic Obstructive Pulmonary Disease
For patients with severe chronic obstructive pulmonary disease, inhaled preventer therapy reduces exacerbations of chronic obstructive pulmonary disease. Hence, when a patient with chronic obstructive pulmonary disease is discharged from hospital, it is assumed that they continue their treatment to avoid readmission. Poor lung function and comorbidities were predictive of poor technique, whereas age and cognition with poor lung function distinguished those with poor adherence and frequent errors in technique. These data may inform clinicians in understanding why a prescribed inhaler is not effective and to devise strategies to promote adherence in COPD.

The COPD Pocket Consultant Guide Mobile App
The COPD Foundation is excited to announce the launch of an updated version of the COPD Pocket Consultant Guide (PCG) app for health care providers. The app, designed to support the treatment and management of COPD, is available for both iOS and Android. The latest version contains an updated therapy chart, including the latest medications, inhaler instruction videos, depression and anxiety screeners, a new pulmonary referral checklist and much more.

In addition, users can toggle between this track and one specifically for patients and caregivers by clicking on “Change View” in the upper right of the main menu screen. The patient and caregiver track has several exciting features, including an interactive "My COPD Action Plan" and tracking calendar; inhaler and exercise videos; activity tracking; a wallet health information card; "For My Next Visit" prompts and more. Details, including instructions and additional resources, are available here.

Additional Resources

The COPD Foundation

The Global Initiative for Chronic Obstructive Lung Disease

The American Lung Association

National Jewish Health: Devices for Inhaled Medications

American Academy of Family Physicians (AAFP): Respiratory Health