Overcoming Therapeutic Inertia to Reduce the Risk of COPD Exacerbations: Four Action Points for Healthcare Professionals

Abstract

Background

Therapeutic inertia, defined as failure to escalate or initiate adequate therapy when treatment goals are not met, contributes to poor management of COPD exacerbations.

Methods

A multidisciplinary panel of five expert clinicians actively managing COPD and representative of UK practice developed action points to reduce exacerbation risk, based on evidence, clinical expertise, and experience. The action points are applicable despite changing circumstances (eg, virtual clinics). The panel agreed areas where further evidence is needed.

Results

The four action points were (1) an experienced HCP, such as a GP or member of the multi-professional COPD team should review patients within one month of every exacerbation that requires oral steroids, antibiotics, or hospitalization to address modifiable risk factors, optimize non-pharmacological measures, and evaluate pharmacological therapy. (2) Presenting to hospital with an exacerbation defines an important window of opportunity to reduce the risk of further exacerbations. Follow-up by a GP, or member of the multi-professional specialist COPD team within one month of discharge with a full management review and appropriate escalation of pharmacological treatment is essential. (3) Healthcare professionals (HCPs) in all healthcare settings should be able to recognize COPD exacerbations, refer as appropriate and document the episode accurately in medical records across service boundaries. HCPs should support patients to recognize and report exacerbations. (4) HCPs should intervene proactively based on risk assessments, disease activity and any treatable traits at or as soon as possible after diagnosis and annually thereafter. Delivering these action points needs coordinated action with policymakers, funders, and service providers.

Conclusion

These action points should be a fundamental part of clinical practice to determine if a change in management is necessary to reduce the risk of exacerbations. Policymakers should use these action points to develop systems and initiatives that reduce the risk of further exacerbations.

Keywords:

• control
• inhaled therapy
• primary care
• mortality
• biomarkers
• health policy

Acknowledgments

ENGINE MHP, provided medical writing assistance and provided a ‘secretariat’ role to the multidisciplinary National Working group, both funded by AstraZeneca, which reviewed the manuscript and made suggestions for the authors to consider.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Claire Adams: Honoraria and speaker fees from AstraZeneca; Boehringer Ingelheim; Chiesi; Napp; GlaxoSmithKline; Mona Bafadhel: Research Grants from AstraZeneca. Educational Talks with AstraZeneca, Cipla and GlaxoSmithKline. Scientific Advisor to ProAxsis and Albus Health and is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). Steve Holmes: Honoraria and speaker fees in the last 2 years from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Napp, Roche, Teva, Trudell, Viatris. John R Hurst: Support to attend meetings, and personal payment and payment to his employer (UCL) for educational and advisory work from pharmaceutical companies that make medicines to treat COPD including AstraZeneca, Chiesi and Boehringer Ingelheim. Dave Singh: Grants and personal fees from Aerogen, AstraZeneca, CSL Behring, Boehringer Ingelheim, Chiesi, Cipla, Epiendo, Genentech, GlaxoSmithKline, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Pulmatrix, Sanofi, Synairgen, Teva, Theravance and Verona, and is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC). The authors report no other conflicts of interest relevant to this work.

Additional information

Funding

AstraZeneca funded medical writing assistance and the “secretariat” role to the multidisciplinary National Working group.