Evaluation of Inhaler Prescribing Trends in Hospitalized Patients With Suspected but Unconfirmed Chronic Obstructive Pulmonary Disease

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommends initial bronchodilator therapy over inhaled corticosteroids (ICS) for most patients. However, real-world prescribing often diverges. Management is further complicated in hospitalized patients with suspected but unconfirmed chronic obstructive pulmonary disease (COPD), where providers must decide on therapy initiation and outpatient follow-up. Objective: To describe inhaler prescribing in suspected but unconfirmed COPD upon hospital discharge. Methods: This was an institutional review board–approved retrospective cohort study of patients of ages 40 years or older with a smoking history of at least 10-pack years, but without a prior COPD diagnosis, who presented with a suspected COPD exacerbation or acute respiratory failure secondary to suspected COPD. The primary outcome was inhaler prescribing at discharge. Secondary outcomes included confirmed COPD diagnosis, guideline concordance, hospital readmission for a COPD exacerbation, and ICS-related adverse events within 180 days. Results: Of the 51 patients included in the study, 29 (56.9%) were prescribed new inhalers, with 15 (29.4%) prescribed ICS-containing regimens. Following discharge, 15 patients (29.4%) completed pulmonary function testing, with 8 (15.7%) receiving a COPD diagnosis. Guideline concordance could not be assessed due to absent documentation. Eight patients (15.7%) were readmitted with a COPD exacerbation, and 13 ICS-related adverse events were documented. Limitations include the sample size and retrospective study design. Conclusion: This study found a high frequency of initial ICS prescribing for suspected but unconfirmed COPD, as well as limited follow-up and diagnostic reassessment. These findings highlight the need for system-level interventions to optimize discharge prescribing and ensure timely follow-up.