CLINICAL CHARACTERISTICS AND MEDICATION MANAGEMENT OF LONG-TERM CARE RESIDENTS WITH COPD IN NURSING FACILITIES

SESSION TITLE: Monday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: COPD is common in nursing facilities (NF), affecting about 20% of residents. There is limited information on the clinical characteristics of NF residents with COPD, and evidence suggests that residents may be undertreated. A better understanding of disease severity, comorbidities, and medication use may lead to more informed decisions regarding the care of NF residents with COPD. METHODS: This cross-sectional assessment included NF residents who were long-stay (≥6 months), at least 60 years of age with a documented diagnosis of COPD. We excluded those on hospice or with severe cognitive impairment. From the two most recent federally-mandated Minimum Dataset 3.0 assessments, we collected demographic, diagnosis, functional status, and mobility data. Spirometry was used to measure lung function. COPD impact and dyspnea were measured by the COPD Assessment Test (CAT), and the modified medical research council (mMRC) questionnaire, respectively. Hospitalizations and medications were collected from the electronic health record. Exacerbations were defined as a prescription for short-term respiratory antibiotics and/or corticosteroids, or a COPD-related hospitalization in the previous six months. Descriptive statistics were used to examine NF resident characteristics and medical management. RESULTS: A total of 135 residents were enrolled from 26 NFs. Mean age was 78.4 years, 76.3% were white, and 65.9% female. The mean BMI was 29.6 ± 10.3 kg/m2. The most prevalent comorbidities were hypertension (83.0%), depression (52.6%), heart failure (45.2%), and anemia (37.8%). Mean forced expiratory volume in one second (% predicted) was 48.8 ± 21.1 indicating severe air flow limitation. Eighty percent of residents scored >10 on the CAT and 77.5% of residents scored >2 on mMRC suggesting a high COPD symptom burden. Mobility devices were used by about 89% of residents with 28.1% limited to wheelchair use. Approximately 20% of study residents had two or more exacerbations in the previous 6 months and 8% had a COPD-related hospitalization. Approximately 45% were not receiving a long-acting bronchodilator (LABD). Use of a nebulizer to deliver medication was present in 45% of residents with nebulization being the only delivery method in about 25% of all residents. CONCLUSIONS: In this study, NF residents with COPD had a high rate of comorbid illness with significant physical limitation, severe air flow limitation and a high COPD symptom burden. Almost one-half of patients were not receiving LABD maintenance therapy. CLINICAL IMPLICATIONS: NF residents with COPD have evidence of severe disease and additional work is needed to determine if treatment outcomes are being optimized. DISCLOSURES: Research support relationship with Sunovion Please note: >$100000 Added 03/13/2019 by Harley Davidson, source=Web Response, value=Grant/Research Support Employee relationship with Sunovion Pharmaceuticals Inc Please note: >$100000 Added 03/11/2019 by Carole Dembek, source=Web Response, value=Salary Advisory Committee Member relationship with Sanofi Please note: $5001 - $20000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Consulting fee Removed 03/12/2019 by Stefan Gravenstein, source=Web Response Advisory Committee Member relationship with Sanofi Please note: $20001 - $100000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Consulting fee Removed 03/12/2019 by Stefan Gravenstein, source=Web Response Speaker/Speaker's Bureau relationship with Seqirus Please note: $5001 - $20000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Honoraria Advisory Committee Member relationship with Merck Please note: $1001 - $5000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Genentech Please note: $1001 - $5000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Sanofi Please note: $20001 - $100000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Honoraria Advisory Committee Member relationship with Sanofi Please note: $5001 - $20000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Consulting fee Research support relationship with Seqirus Please note: $20001 - $100000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Grant/Research Support research support relationship with Sanofi Please note: $20001 - $100000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Grant/Research Support research support relationship with Sunovion Please note: $5001 - $20000 Added 03/12/2019 by Stefan Gravenstein, source=Web Response, value=Grant/Research Support Research Support relationship with Sunovion Pharmaceuticals Please note: >$100000 Added 03/12/2019 by Lisa Han, source=Web Response, value=Grant/Research Support Clinical Research Organization relationship with Sunovion Pharmaceuticals Please note: >$100000 Added 03/06/2019 by Peter Radlowski, source=Web Response, value=Grant/Research Support Research collaborator (subcontract) relationship with Insight Therapeutics Please note: >$100000 Added 03/13/2019 by Theresa Shireman, source=Web Response, value=Grant/Research Support