• Nick Ladziak and Nicole Paolini Albanese.
• University of Arizona College of Pharmacy, 650 E Van Buren St, Office 3373, Phoenix, AZ 85004. Email: ladziak@pharmacy.arizona.edu.
• Am J Manag Care. 2019 Apr 1; 25 (4): 201-204.

ObjectivesTo determine if symptoms changed after changing chronic obstructive pulmonary disease (COPD) triple-therapy inhalers to a less expensive regimen.Study DesignRetrospective observational case-series analysis.MethodsA quality improvement program was instituted to reduce drug costs associated with COPD inhalers between fall 2016 and spring 2017. Patients identified as taking an inhaled corticosteroid (ICS)/long-acting β agonist (LABA) inhaler and a long-acting muscarinic agonist (LAMA) inhaler were changed to a LAMA/LABA inhaler and an ICS inhaler. Symptoms were assessed at baseline and subsequent follow-up using the COPD Assessment Test (CAT), with lower scores representing better symptom control. Then, a retrospective observational case-series analysis of 118 patient charts was completed. The primary outcome was mean difference in CAT score. Data were analyzed using a paired t test with an α value of 0.05.ResultsOf 118 patients included in the quality improvement program, 19 met the inclusion and exclusion criteria. The mean (SD) CAT score prior to the change was 15.53 (5.36), and the mean (SD) CAT score after the change was 14.68 (6.98). Symptom scores improved after the change, with an average difference in postchange and prechange CAT scores of -0.84, although this difference was not statistically significant (95% CI, -3.57 to 1.89; P = .525).ConclusionsBased on the results of this observational review, changing COPD triple-therapy inhalers did not result in a significant change in patient-reported symptom scores. Patients may use triple-therapy inhalers that are most affordable without a significant change in symptom control.

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