Pharmacotherapy Management of COPD Exacerbation (PCE)

The percentage of COPD exacerbations for persons 40 years of age and older who had an acute inpatient discharge or ED visit on or between January 1–November 30 of the measurement period and were dispensed appropriate medications. Two rates are reported: 

  1. Dispensed a systemic corticosteroid (or there was evidence of an active prescription) within 14 days of the event. 
  2. Dispensed a bronchodilator (or there was evidence of an active prescription) within 30 days of the event. 

Why it Matters

COPD defines a group of diseases characterized by airflow obstruction, and includes chronic bronchitis and emphysema. Symptoms of COPD range from chronic cough and sputum production to severe, disabling shortness of breath, leading to significant impairment of quality of life (1). COPD is a major cause of chronic morbidity and mortality. The National Heart, Lung, and Blood Institute (NHLBI) estimates that over 16 million adults have been diagnosed with COPD, but that the actual number of those with the disease may be higher (2). While other major causes of death have been decreasing, COPD mortality has risen, making it the fourth leading cause of death in the U.S (3). 

Exacerbations may be the most significant drivers of negative impacts on a COPD patient (4). Patients experiencing exacerbations are at higher risk for repeat exacerbations, more rapid decline in lung function, and reduced exercise capacity and these effects are more pronounced for patients with severe COPD (5). In addition to physical effects, COPD exacerbations result in reduced quality of life and ability to conduct activities of daily living independently (6). Proper therapy following an exacerbation, including pharmacotherapy, can slow disease progression and reduce the risk of future exacerbations (7). 

Guidelines recommend the use of bronchodilators and systemic steroids as treatment for COPD exacerbations (7). 

Historical Results – National Averages

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References

  1. Globe, G., B. Currie, N.K. Leidy, P. Jones, D. Mannino, F. Martinez, P. Klekotka, S. O’Quinn, N. Karlsson, & I. Wiklund. 2016. “Development of the Chronic Obstructive Pulmonary Disease Morning Symptom Diary (COPD-MSD).” Health and Quality of Life Outcomes 14(1), 104. https://doi.org/10.1186/s12955-016-0506-7
  2. National Heart, Lung and Blood Institute. COPD National Action Plan. https://www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan (Accessed May 1, 2020)
  3. Centers for Disease Control and Prevention (CDC). 2019. COPD. https://www.cdc.gov/dotw/copd/index.html (Accessed May 1, 2020)
  4. Donaldson, G.C., T.A.R. Seemungal, A. Bhowmik, and J.A. Wedzicha. 2002. “Relationship Between Exacerbation Frequency and Lung Function Decline in Chronic Obstructive Pulmonary Disease.” Thorax 57:847–52.
  5. Spencer, S., P.M.A. Calverley, P.S. Burge, and P.W. Jones. 2004. “Impact of Preventing Exacerbations on Deterioration of Health Status in COPD.” European Respiratory Journal 23:698–702.
  6. Miravitlles, M., M. Ferrer, A. Pont, et al. 2004. “Effect of Exacerbations on Quality of Life in Patients With Chronic Obstructive Pulmonary Disease: A 2 Year Follow Up Study.” Thorax 59:387-395. doi: 10.1136/thx.2003.008730.
  7. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. https://goldcopd.org/wp-content/uploads/2019/11/GOLD-2020-REPORT-ver1.0wms.pdf (Accessed May 1, 2020)

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