Abstract Rationale Pulmonologist specialist care has been associated with improved adherence to guideline-directed medical therapy for COPD and is required for the initiation of biologics. However, current guidelines provide limited direction on referral timing, and the real-world trajectory of exacerbations around specialist visits is not well characterized. Therefore, this study examined within-person changes in annual rates of acute exacerbations of COPD (AECOPD) in the year before versus after an initial pulmonology specialist visit among patients with COPD with recent exacerbations. Methods This observational, retrospective study utilized the 100% Medicare Fee-for-Service (FFS) and Inovalon MORE2 Registry® databases. Inclusion criteria: 1) COPD diagnosis (1/1/2021-12/31/2023); 2) qualifying AECOPD, ( ≥1 severe, ≥2 moderate, or ≥ 1 moderate with maintenance therapy; exacerbation index date); 3) aged 40-85; 4) ≥12 months of continuous enrollment preceding and following the qualifying AECOPD and the first specialist visit; and 5) ≥1 severe or ≥ 2 moderate qualifying AECOPD in the 12 months prior to the specialist visit. AECOPD were defined as moderate (outpatient COPD visit accompanied by oral corticosteroid or oral antibiotic within 14 days or ≥ 1 corticosteroid injection or severe (COPD or related respiratory hospitalization) and were assessed in the 12 months preceding and following the initial specialist visit. Paired t-tests compared means between periods. This study lacked a contemporaneous comparator arm and cannot establish causality. Results A total of 24,741 patients with COPD completed a specialist visit. The mean±SD age of the study sample was 66.3±10.0 years; the majority of patients were female (n = 15,662; 63.3%); 48.7% (n = 12,047) were enrolled in Medicare FFS. The proportion of patients with ≥1 AECOPD declined from 100% to 66.1% after the specialist visit. The annual AECOPD rate declined from 2.0 to 1.4 exacerbations/year. The severe AECOPD rate declined from 0.43 to 0.15 exacerbations/year, while the moderate AECOPD rate decreased from 1.58 to 1.25 exacerbations/year. Conclusions In a real-world setting, within-person AECOPD rates were lower in the 12 months following an initial specialist visit compared with the prior 12 months. Findings should be considered hypothesis generating rather than causal and suggest the importance of specialist involvement in comprehensive COPD management. This abstract is funded by: AstraZeneca
Gray et al. (Fri,) studied this question.