2026 Southeastern Residency Conference

Purpose: Chronic obstructive pulmonary disease (COPD) is one of the most prominent disease states, affecting nearly 16 million people and ranking as one of the top ten causes of mortality. Improper treatment of COPD can lead to disease progression, increased risk of exacerbations, decreased quality of life, and a negative financial impact on the patient. Inhaled corticosteroids (ICS) are not recommended as initial treatment in COPD per the 2025 GOLD report and overprescribing can lead to unnecessary risks. The objective of this study is to investigate the current utilization of ICS therapy in COPD at the Central Alabama Veterans Health Care System (CAVHCS).

Methods: This quality improvement project is a retrospective, observational review of the prescribing of ICS  to Veterans with a diagnosis of COPD being treated at CAVHCS from October 1, 2019 to September 5, 2025. A more extensive chart review was completed on a random sample of 100 Veterans from an original sample size of 3,791. Data collected includes Veteran demographics, COPD diagnosis (ICD code), active inhaler prescriptions, documented indications for ICS use, eosinophil counts, FEV1/FVC results, CT scans, X-Rays, history of exacerbations, and hospitalization rates. The data was compiled in a de-identified Microsoft Excel spreadsheet for analysis. Primary outcome assessed was the percentage of Veterans with COPD who have been appropriately prescribed ICS-inhaler therapy.  Secondary outcomes include the rate of eosinophil counts monitored prior to initiation of ICS-inhaler therapy, the rate of exacerbations in Veterans with a COPD diagnosis on ICS-inhaler therapy, and the difference in lung function (FEV1/FVC) prior to and following initiation of ICS therapy in Veterans with COPD. 

Results: 100 Veterans at CAVHCS diagnosed with COPD were randomly selected for screening and assessment and exactly half of them were prescribed ICS therapy. Of the 50 patients found to be prescribed ICS therapy, 30 of them were prescribed by prescribers actively working at CAVHCS. The other 20 Veterans were prescribed ICS therapy from those outside of the health care system or were prescribed at another VA facility and their medications were reconciled and continued.  For the 30 Veterans who had been prescribed ICS therapy by our health system’s providers, 50% of them were determined to have been appropriately prescribed. Of the remaining 50% of patients, 33% were determined to have been inappropriately prescribed and in 15% of patients we were unable to determine appropriateness (e.g unavailable records). In regard to secondary outcomes, there were eight documented and diagnosed episodes of exacerbations. PFTs were documented in 64% of patient charts screened and 85% of Veterans had documented eosinophils.

Conclusions: Results from this project have outlined a prominent disconnect between evidence-based guidelines and prescriber patterns. This affirms the need for providing comprehensive education to our prescribers on the good practice of ICS therapy prescribing. Giving education to providers will close the gap between provider knowledge and prescribing practices, in turn leading to decreased side effects from unnecessary medication use and improved outcomes for our Veterans.