Pragmatic research and outcomes in asthma and COPD
2012
Asthmaand chronic obstructive pulmonary disease (
COPD) are common diseases which cause patients and society considerable difficulties. These are costly diseases which cause substantial morbidity and death. Health care policy makers have made improving outcomes in
asthmaand
COPDa priority. Application of guideline recommended approaches to
asthmaand
COPDcare in the real-life setting has been emphasized but outcomes have not improved. Failure to improve outcomes may not be because of inconsistent applications of guideline recommendations, but rather because there are difficulties implementing the Expert Panel Report III (EPR 3) method for categorizing
asthmaseverity and the Global Initiative for
Obstructive Lung Disease(GOLD) method for diagnosing
COPD. As these serve as the foundation for treatment recommendations for these diseases, alternative approaches should be considered for categorizing
asthmaseverity and identifying
COPDpatients. Claims-based algorithms provide an intriguing option for identifying persistent
asthmapatients and symptomatic
COPDpatients in administrative databases. These methods could be used as the basis for pragmatic research, both retrospective and prospective, on assessing outcomes of guideline recommended treatment approaches in
asthmaand
COPD. Important questions urgently need to be answered about how guideline recommended approaches regarding use of long-acting inhaled β-agonist/inhaled corticosteroid (LABA/ICS) in
asthmaand long-acting inhaled anti-muscarinic agent (LAMA) and LABA/ICS in
COPDaffect outcomes in real-life situations.
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