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Pharmacist-Led Deprescribing of Inappropriately Prescribed Inhaled Corticosteroids in Veterans with Chronic Obstructive Pulmonary Disease
Friday April 25, 2025 11:00am - 11:15am EDT
Athena C
Title: 
Pharmacist-Led Deprescribing of Inappropriately Prescribed Inhaled Corticosteroids in Veterans with Chronic Obstructive Pulmonary Disease


 Authors:
Jessica Parks, Amber Jefferson, Lauren Howard, Cassandra Warsaw


Introduction:
Chronic obstructive pulmonary disease (COPD) management consists of bronchodilators and inhaled corticosteroid (ICS). ICS use is recommended with a history of COPD hospitalizations, two or more moderate COPD exacerbation within the last two years, eosinophil (EOS) count of 300 cells/µL or higher, or if the patient is diagnosed with concomitant asthma. ICS should be considered as a last-line option due to increased risk for oral candidiasis, hoarse voice, and pneumonia. Previous studies have shown benefits of pharmacist-led clinics for the management of chronic disease states. The purpose of this quality improvement initiative was to investigate the impact of pharmacist-led deprescribing of inappropriately prescribed inhaled corticosteroids in Veterans with COPD, regardless of initial ICS-containing regimens.


Methods:
Retrospective chart reviews were completed for the initiative. A total of 123 Veterans, identified using the COPD Dashboard, were included in the review. Descriptive statistics were used for data analysis. Veterans were included if assigned to the designated primary care clinic, diagnosed with COPD, and had an active ICS prescription. A total of 54 Veterans met inclusion criteria. Charts were reviewed for an appropriate indication for ICS use. Updated pulmonary function tests (PFTs) and complete blood cell counts (CBC) were scheduled with consent. If the ICS was deemed inappropriate, then the pharmacist contacted the Veteran via telephone to provide education and utilized Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines to determine appropriate therapy. Veterans were contacted via telephone to conduct a COPD management appointment, and based on patient-specific factors, the pharmacist recommended to either discontinue or continue the ICS-containing inhaler. If an ICS was discontinued, a long-acting muscarinic antagonist (LAMA) or LAMA/long-acting bronchodilator agonist (LABA) was prescribed as alternative therapy. Interventions were documented in the electronic health record using a specified note template. Data collection occurred between July and November 2024. The project was approved by the Pharmacy and Therapeutics committee as a quality improvement initiative, which is exempt from IRB approval.


Results:
Upon examination of charts, it was noted that PFT results and CBC lab work were outdated in accordance to GOLD guidelines for COPD therapeutic management. A total of 21 Veterans obtained updated PFTs and 9 Veterans obtained updated CBC labs. There were a total of 54 Veterans that met inclusion criteria and there were a total of 33 Veterans deemed appropriate for ICS deprescribing. Overall, 76% (N=25) of Veterans agreed to ICS de-escalation.


Conclusions:
The data collected further supports the necessity of pharmacist-led clinics to ensure appropriate medications are prescribed and monitoring parameters are upheld. Additionally, pharmacist-led deprescribing of inappropriate ICS inhalers reduces the risk of adverse effects and enables pharmacists to identify patients requiring updated COPD monitoring.
Moderators
avatar for Devin Lavender

Devin Lavender

Clinical Assistant Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2
Ambulatory Care, Scholarship of Teaching and Learning, Resident and Student Development.
Presenters
avatar for Jessica Parks

Jessica Parks

PGY-2 Ambulatory Care Pharmacy Resident, Fayetteville VA Health Care Center
Jessica Parks, Pharm.D. is a PGY-2 Ambulatory Care resident. She earned her Doctor of Pharmacy Degree from Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. She completed her PGY-1 pharmacy residency at the Erie VA Medical Center. Her practice interests include chronic... Read More →
Evaluators
CW

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, Kaiser Permanente Georgia
Friday April 25, 2025 11:00am - 11:15am EDT
Athena C
  Ambulatory Care (AMB), VA - Fayetteville, NC – Fayetteville VA Coastal Health Care System
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