COPD Med Optimization

February 7, 2025

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide.1

According to the GOLD Guidelines, goals for treatment of stable COPD include:

 -  Reducing symptoms
 -  Reducing risk (for the most recent GOLD Guideline recommendations, see https://goldcopd.org/2025-gold-report/)

Management of COPD should be individualized and based on symptom severity, risk of exacerbations, side-effects, comorbidities, and cost. However, single inhaler therapy has been shown to improve adherence to treatment.

The GOLD Guidelines utilize the ABE assessment in the chart below to evaluate a patient’s COPD based on current symptoms, airflow limitation, and history of exacerbation.

 

Care Guidelines

Exacerbation history (per year) ABE Group Assignment
2 moderate exacerbation or > 1 exacerbation leading to hospitalization 

Group E:

LABA+LAMA

Preferred Drug List for LABA + LAMA includes:             

ANORO ELLIPTA, BEVESPI AEROSPHERE, STIOLTO RESPIMAT

*consider LABA+LAMA+ICS if blood eos >300

Preferred Drug List for LABA + LAMA + ICS:

TRELEGY ELLIPTA 
0 or 1 moderate exacerbation (not leading to hospitalization)

Symptoms:

mMRC 0-1 or CAT<10 

Symptoms:

mMRC>2 or CAT > 10

Group A:

Inhaled Bronchodilator

Preferred Drug List Options include:
Spiriva Handihaler/Respima, Incruse Ellipta

Group B:

LABA+LAMA (see above for formulary LABA + LAMA)

 

Combination SABA+SAMA therapy is shown to be more effective than either agent alone in improving FEV1 and symptoms

  • On formulary combination SABA+SAMA
    • COMBIVENT RESPIMAT 20-100 MCG/ACT

Additional Patient Counseling Notes:

  • Patient’s inhaler technique and adherence to pharmacotherapy should be assessed regularly.
  • Patients should be encouraged to quit smoking and provided pharmacotherapy to do so depending on willingness to quit status.
  • Lung cancer screening should be completed in patients with COPD due to smoking annually.
  • Ensure patients are up to date on COVID-19, Influenza, RSV, Pneumonia, Tdap as appropriate as these can reduce risk of viral respiratory infections that can cause COPD exacerbations.
  • Pulmonary rehabilitation improves exercise capacity, symptoms, and quality of life across all groups of COPD severity.