Student Name
Capella University
NURS-FPX4025 Research and Evidence-Based Decision Making
Prof. Name
Date
NURS FPX 4025 Assessment 3 Applying the PICO(T) Process
Title
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder characterized by airflow obstruction, chronic mucus accumulation, and persistent shortness of breath. The condition can worsen over time, leading to exacerbations that compromise lung function. Effective management focuses on symptom control, reducing exacerbation frequency, and slowing disease progression. COPD is a leading cause of mortality in the United States, affecting approximately 16 million adults (CDC, 2024). Selecting the most appropriate therapeutic regimen can significantly influence patient outcomes. This assessment compares the efficacy of Long-Acting Beta-Agonist (LABA) therapy with triple therapy (LABA/LAMA/ICS) in patients with moderate to severe COPD over a three-month period, focusing on symptom control and exacerbation reduction.
Explaining a Diagnosis
COPD is a chronic, debilitating disease characterized by irreversible airflow limitation, airway remodeling, and mucus hypersecretion. In 2021, the prevalence of COPD among U.S. adults was approximately 6.0%, showing little change over the past decade (CDC, 2024). Management strategies aim to prevent exacerbations, improve quality of life, and alleviate symptoms. Patients with stable COPD may not experience immediate complications; however, uncontrolled disease can lead to severe outcomes such as respiratory failure, pulmonary hypertension, and heightened susceptibility to infections like pneumonia (Lea et al., 2023).
Patients experiencing frequent exacerbations are at an increased risk of hospitalization and mortality due to declining lung function. Vulnerable populations, including the elderly and those with lower socioeconomic status, face higher risks due to limited access to specialist care, pulmonary rehabilitation, and smoking cessation programs (Lea et al., 2023). For example, rural residents often have reduced access to rehabilitation programs, decreased physical performance, and a higher frequency of exacerbations.
Financial barriers also impact disease management. Patients with lower incomes may struggle to afford long-term medications, including maintenance bronchodilators, which can result in uncontrolled symptoms and accelerated disease progression. Additionally, inappropriate use of inhaled corticosteroids (ICS), often due to withdrawal anxiety, increases the risk of pneumonia, especially in older or immunocompromised patients. Optimizing LABA therapy and appropriately tapering ICS use can reduce complications and promote health equity in COPD care (Lee et al., 2021).
PICO(T) Research Question
A structured PICO(T) framework guides evidence-based evaluation for COPD treatment optimization. The research question is:
“In COPD patients (P), how does LABA therapy (I), compared to triple therapy with ICS (C), affect the frequency of exacerbations and symptom control (O) over a period of 3 months (T)?”
PICO(T) Components
| Component | Definition |
|---|---|
| P (Patient/Population) | Adults diagnosed with COPD at risk of exacerbations who may require long-term inhaled therapy. |
| I (Intervention) | Long-acting beta-agonist (LABA) therapy designed to improve airflow, reduce symptoms, and enhance lung function. |
| C (Comparison) | Triple therapy (LABA/LAMA/ICS), which includes an inhaled corticosteroid; may carry increased risks such as pneumonia. |
| O (Outcome) | Reduction in exacerbation frequency and improvement in symptom control, reflecting effective disease management. |
| T (Timeframe) | Three months, allowing for assessment of short-term treatment efficacy and comparison between LABA monotherapy and triple therapy. |
This PICO(T) question provides a systematic approach to identifying evidence that determines whether LABA monotherapy is sufficient or if triple therapy is required.
Literature Search
A comprehensive search was conducted to identify evidence comparing LABA therapy and triple therapy (LABA/LAMA/ICS) in adult COPD patients. Databases searched included PubMed, CINAHL, Cochrane Library, and Google Scholar. Initial keywords included COPD, LABA therapy, triple therapy, ICS withdrawal, exacerbation prevention, symptom management, and long-term COPD treatment. Boolean operators (AND, OR) refined results to focus on studies directly comparing LABA and triple therapy.
The CRAAP criteria (Currency, Relevance, Authority, Accuracy, Purpose) guided the evaluation of evidence (Dehkordi et al., 2024). Priority was given to systematic reviews, meta-analyses from the past five years, peer-reviewed articles, and sources from recognized organizations, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Specific search refinements, such as “ICS step-down in COPD” and “dual bronchodilator therapy efficacy,” narrowed the results to studies most relevant to the research question (GOLD, 2023). Only full-text English publications targeting adult COPD patients were included, ensuring the relevance and applicability of evidence.
Relevant Articles
Four high-quality studies were identified to compare LABA therapy versus triple therapy for moderate to severe COPD. These studies were evaluated for credibility, relevance, and applicability.
Fukuda et al. (2023) conducted a systematic review of 19 randomized controlled trials (22,354 participants; median age 64; 70% male; median FEV1 51.5%). Findings indicated that triple therapy reduced exacerbation rates, whereas LABA monotherapy provided similar symptom control for patients without a history of frequent exacerbations.
Davidescu et al. (2023) examined ICS withdrawal in COPD patients, finding that patients with eosinophil counts below 300 cells/mm³ did not experience increased exacerbations after switching to LABA monotherapy.
Zhang et al. (2024) analyzed the safety and efficacy of triple therapy versus LABA therapy, showing that stable patients maintained efficacy with LABA, while frequent exacerbators benefited more from triple therapy.
GOLD (2023) guidelines emphasized personalized treatment strategies, recommending LABA over triple therapy for patients without frequent exacerbations.
Analyzing Evidence
Evidence supports the concept that treatment should be individualized. LABA therapy provides adequate symptom control for stable COPD patients, whereas triple therapy is more effective in reducing exacerbations among frequent exacerbators. The studies collectively emphasize the importance of balancing therapeutic efficacy with minimizing the risks associated with ICS use, including pneumonia. Personalized treatment based on disease severity, exacerbation frequency, and biomarker levels (e.g., eosinophil counts) ensures optimal outcomes while avoiding unnecessary drug exposure.
Conclusion
Effective COPD management requires individualized treatment strategies that balance symptom control with exacerbation prevention. LABA therapy is sufficient for stable patients, while triple therapy offers additional benefits for frequent exacerbators. Evidence-based guidelines recommend tailoring therapy to each patient’s clinical profile, ensuring optimal outcomes and reducing the risks of inappropriate medication use.
References
Centers for Disease Control and Prevention (CDC). (2024, June 12). COPD. Chronic Disease Indicators. https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html
Davidescu, L., Andrei , D., Mekeres, F., Goman, A., Stefania , N., & Rajnoveanu, R. (2023). Phenotype of COPD: “Frequent exacerbator” and biomarkers use in clinical practice. Pharmacophore, 14(4), 40–49. https://doi.org/10.51847/yyzhyvtysb
Dehkordi, M. K., Hanson, H. M., Kennedy, M., & Wagg, A. (2024). Mapping quality indicators to assess older adult health and care in community-, continuing-, and acute-care settings: A systematic review of reviews and guidelines. Healthcare, 12(14), 1397. https://doi.org/10.3390/healthcare12141397
Fukuda, N., Horita, N., Kaneko, A., Goto, A., Kaneko, T., Ota, E., & Kew, K. M. (2023). Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease. The Cochrane Library, 2023(6). https://doi.org/10.1002/14651858.cd012066.pub3
GOLD. (2023). Global Initiative for Chronic Obstructive Lung Disease – GOLD. Global Initiative for Chronic Obstructive Lung Disease.org. https://goldcopd.org/
NURS FPX 4025 Assessment 3 Applying the PICO(T) Process
Lea, S., Higham, A., Beech, A., & Singh, D. (2023). How inhaled corticosteroids target inflammation in COPD. European Respiratory Review, 32(170), e230084. https://doi.org/10.1183/16000617.0084-2023
Lee, H. W., Kim, H. J., Jang, E. J., & Lee, C.-H. (2021). Comparisons of efficacy and safety between triple (inhaled corticosteroid/long-acting muscarinic antagonist/long-acting beta-agonist) therapies in chronic obstructive pulmonary disease: Systematic review and Bayesian network meta-analysis. Respiration, 100(7), 631–643. https://doi.org/10.1159/000515133
Zhang, S., Wang, J., Li, X., & Zhang, H. (2024). Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: An overview of systematic reviews. Therapeutic Advances in Respiratory Disease, 18. https://doi.org/10.1177/17534666241259634