{"doi":"10.17615/0166-0596","title":"Alignment of inhaled chronic obstructive pulmonary disease therapies with published strategies :analysis of the Global Initiative for Chronic Obstructive Lung Disease recommendations in SpiroMics","abstract":"Rationale: Despite awareness of chronic obstructive pulmonary disease (COPD) treatment recommendations, uptake is poor. The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) spans 2010-2016, providing an opportunity to assess integration of 2011 Global Initiative for Obstructive Lung Disease (GOLD) treatment strategies over time in a large observational cohort study. Objectives: To evaluate how COPD treatment aligns with 2011 GOLD strategies and determine factors associated with failure to align with recommendations. Methods: Information on inhaled medication use collected via questionnaire annually for 4 years was compiled into therapeutic classes (long-acting antimuscarinic agent, long-acting b-agonist, inhaled corticosteroids [ICS], and combinations thereof). Medications were not modified by SPIROMICS investigators. 2011 GOLD COPD categories A, B, C, and D were assigned. Alignment of inhaler regimen with first-/second-line GOLD recommendations was determined, stratifying into recommendation aligned or nonaligned. Recommendation-nonaligned participants were further stratified into overuse and underuse categories. Results: Of 1,721 participants with COPD, at baseline, 52% of regimens aligned with GOLD recommendations. Among participants with nonaligned regimens, 46% reported underuse, predominately owing to lack of long-acting inhalers in GOLD category D. Of the 54% reporting overuse, 95% were treated with nonindicated ICS-containing regimens. Among 431 participants with 4 years of follow-up data, recommendation alignment did not change over time. When we compared 2011 and 2017 recommendations, we found that 47% did not align with either set of recommendations, whereas 35% were in alignment with both recommendations. Conclusions: Among SPIROMICS participants with COPD, nearly 50% reported inhaler regimens that did not align with GOLD recommendations. Nonalignment was driven largely by overuse of ICS regimens in milder disease and lack of long-acting inhalers in severe disease.","journal":"UNC Libraries","year":2021,"id":229938,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9525,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":365725,"name":"N.N. Hansel","orcid":null,"position":1,"is_corresponding":false},{"id":365740,"name":"E.C. Kleerup","orcid":null,"position":2,"is_corresponding":false},{"id":453935,"name":"C. Galban","orcid":null,"position":3,"is_corresponding":false},{"id":365728,"name":"D.P. Tashkin","orcid":null,"position":4,"is_corresponding":false},{"id":365722,"name":"N. Putcha","orcid":null,"position":5,"is_corresponding":false},{"id":365710,"name":"J.A. Krishnan","orcid":null,"position":6,"is_corresponding":false},{"id":365706,"name":"R.A. Wise","orcid":null,"position":7,"is_corresponding":false},{"id":365702,"name":"S.A. Christenson","orcid":null,"position":8,"is_corresponding":false},{"id":453930,"name":"S.P. Bhatt","orcid":null,"position":9,"is_corresponding":false},{"id":365734,"name":"S.C. Lazarus","orcid":null,"position":10,"is_corresponding":false},{"id":340966,"name":"N.E. Alexis","orcid":null,"position":11,"is_corresponding":false},{"id":365719,"name":"A.T. Hastie","orcid":null,"position":12,"is_corresponding":false},{"id":365714,"name":"L.M. LaVange","orcid":null,"position":13,"is_corresponding":false},{"id":365724,"name":"P.G. Woodruff","orcid":null,"position":14,"is_corresponding":false},{"id":365709,"name":"R.C. Boucher","orcid":null,"position":15,"is_corresponding":false},{"id":140348,"name":"R. Paine","orcid":null,"position":16,"is_corresponding":false},{"id":453933,"name":"L. Postow","orcid":null,"position":17,"is_corresponding":false},{"id":544142,"name":"R. Graham Barr","orcid":"0000-0002-0743-2303","position":18,"is_corresponding":false},{"id":365723,"name":"S.I. Rennard","orcid":null,"position":19,"is_corresponding":false},{"id":453943,"name":"M. Arjomandi","orcid":null,"position":20,"is_corresponding":false},{"id":453927,"name":"L. Viviano","orcid":null,"position":21,"is_corresponding":false},{"id":365745,"name":"C.M. Doerschuk","orcid":null,"position":22,"is_corresponding":false},{"id":365742,"name":"J.L. Curtis","orcid":null,"position":24,"is_corresponding":false},{"id":365736,"name":"R.J. Kaner","orcid":null,"position":25,"is_corresponding":false},{"id":365716,"name":"D.J. Couper","orcid":null,"position":26,"is_corresponding":false},{"id":365738,"name":"R.E. Kanner","orcid":null,"position":27,"is_corresponding":false},{"id":365735,"name":"W.H. Anderson","orcid":null,"position":28,"is_corresponding":false},{"id":365715,"name":"C.B. Cooper","orcid":null,"position":29,"is_corresponding":false},{"id":453941,"name":"W.C. Moore","orcid":null,"position":30,"is_corresponding":false},{"id":43746,"name":"S. Ghosh","orcid":"0000-0002-6524-9830","position":31,"is_corresponding":false},{"id":453929,"name":"L. Paulin","orcid":null,"position":32,"is_corresponding":false},{"id":365733,"name":"E.R. Bleecker","orcid":null,"position":33,"is_corresponding":false},{"id":365721,"name":"D.A. Meyers","orcid":null,"position":34,"is_corresponding":false},{"id":365743,"name":"R.P. Bowler","orcid":null,"position":35,"is_corresponding":false},{"id":365711,"name":"M.T. Dransfield","orcid":null,"position":36,"is_corresponding":false},{"id":140351,"name":"F.J. Martinez","orcid":null,"position":37,"is_corresponding":false},{"id":365730,"name":"W.K. O apos Neal","orcid":null,"position":38,"is_corresponding":false},{"id":453940,"name":"V.E. Ortega","orcid":null,"position":39,"is_corresponding":false},{"id":604695,"name":"J. Michael Wells","orcid":"0000-0001-5047-6224","position":40,"is_corresponding":false},{"id":365744,"name":"C.M. Freeman","orcid":null,"position":41,"is_corresponding":false},{"id":453932,"name":"L.A. Bateman","orcid":null,"position":42,"is_corresponding":false},{"id":365720,"name":"M.K. Han","orcid":null,"position":43,"is_corresponding":false},{"id":26150,"name":"Y. Huang","orcid":"0000-0003-1826-2749","position":44,"is_corresponding":false},{"id":250086,"name":"Michael Drummond","orcid":"0000-0002-6968-4610","position":45,"is_corresponding":false},{"id":365703,"name":"R.G. Crystal","orcid":null,"position":46,"is_corresponding":false},{"id":453934,"name":"S. Raman","orcid":null,"position":47,"is_corresponding":false},{"id":453942,"name":"S.P. Peters","orcid":null,"position":48,"is_corresponding":false},{"id":453936,"name":"B. Drummond","orcid":null,"position":49,"is_corresponding":false},{"id":365726,"name":"G.J. Criner","orcid":null,"position":50,"is_corresponding":false},{"id":365741,"name":"J.D. Newell","orcid":null,"position":51,"is_corresponding":false},{"id":365707,"name":"E.C. Oelsner","orcid":null,"position":52,"is_corresponding":false},{"id":453928,"name":"I. Barjaktarevic","orcid":null,"position":53,"is_corresponding":false},{"id":453945,"name":"A.P. Comellas","orcid":null,"position":54,"is_corresponding":false},{"id":453946,"name":"C. Pirozzi","orcid":null,"position":55,"is_corresponding":false},{"id":365727,"name":"E.A. Hoffman","orcid":null,"position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-18T23:55:01.675482Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}