Missing Potential Opportunities to Reduce Repeat COPD Exacerbations
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Long-acting beta-agonists (LABA) and/or inhaled corticosteroids (ICS) have been shown to reduce COPD exacerbation risk. Using data from a large integrated health-care system, we sought to examine whether these medication classes were initiated after an exacerbation of COPD.
We identified patients who experienced an inpatient or outpatient COPD exacerbation within the Veterans Affairs Integrated Service Network (VISN)-20. We assessed the addition of a new inhaled therapy (an ICS, LABA or both) within 180 days after the exacerbation. We assessed independent predictors of adding treatment using logistic regression.
We identified 45,780 patients with COPD, of whom 2,760 patients experienced an exacerbation of COPD. Of these individuals, 2,570 (93.1 %) were on either none or only one long-acting medication studied (LABA or ICS). In the subsequent 180-day period after their exacerbation, only 875 (34.1 %) patients had at least one of these additional therapies dispensed from a VA pharmacy. Among patients who were treated in the outpatient setting, older age [OR 0.98/year, 95 % CI (0.97–0.99)], current tobacco use [OR 0.74, 95 % CI (0.60–0.90)], greater use of ipratropium bromide [OR 0.97/canister, 95 % CI (0.96–0.98)], prior COPD exacerbation [OR 0.55, 95 % CI (0.46–0.67)], depression [OR 0.77, 95 % CI (0.61–0.98)], CHF [OR 0.74, 95 % CI (0.57–0.97)], and diabetes (OR 0.77 (0.60–0.99)] were associated with lower odds of additional therapy. Patients who were treated in the hospital had similar associated predictors.
Among patients treated for an exacerbation of COPD, we found relatively few were subsequently prescribed inhaled therapies known to reduce exacerbations.
- Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (The BOLD study): a population-based prevalence study. Lancet. 2007;370:741–750. CrossRef
- Seemungal TA DG, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1418–1422. CrossRef
- Decramer MNL, Nardini S, Reardon J, Rochester CL, Sanguinetti CM, Troosters T. Targeting the COPD exacerbation. Respir Med. 2008;102:S3–S15. CrossRef
- Alsaeedi A, Sin DD, McAlister FA. The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials. Am J Med. 2002;113:59–65. CrossRef
- Boyd G, Morice A, Pounsford JC, Siebert M, Peslis N, Crawford C. An evaluation of salmeterol in the treatment of chronic obstructive pulmonary disease (COPD). Eur Respir J. 1997;10:815–821.
- Burge PS, Calverley P, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ. 2000;320:1297–1303. CrossRef
- Hurst JR, Donaldson G, Quint JK, Goldring JJ, Baghai-Ravary R, Wedzicha JA. Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;179:369–374. CrossRef
- Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease NHLBI/WHO workshop report Bethesda, National Heart, Lung and Blood Institute April 2001; NIH Publication No. 270:1–100.
- Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010. Available from: http://www.goldcopdorg/.
- Rabe K, Hurd S, Anzueto A, Barnes P, Buist S, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;6:532–555. CrossRef
- Celli B, MacNee W, Force AET. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–946. CrossRef
- American Thoracic Society / European Respiratory Society Task Force. Standards for the diagnosis and management of patients with COPD [Internet]. Version 1.2. New York: American Thoracic Society; 2004 [updated 2005 September 8]. Available from: http://www.thoracic.org/go/copd. 2004.
- Calverley PMA, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, Yates JC, Vestbo J, for the TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–789. CrossRef
- Mills E, Druyts E, Ghement I, Puhan MA. Pharmacotherapies for chronic obstructive pulmonary disease: a multiple treatment comparison meta-analysis. Clin Epidemiol. 2011;3:107–129.
- Calvin JE, Shanbhag S, Avery E, Kane J, Richardson D, Powell L. Adherence to evidence-based guidelines for heart failure in physicians and their patients: lessons from the Heart Failure Adherence Retention Trial (HART). Congest Heart Fail. 2012;18:73–78. CrossRef
- Komajda M, Lapuerta P, Hermans N, Gonzalez-Juanatey JR, Van Veldhuisen DJ, Erdmann E, Tavazzi L, Poole-Wilson P, Le Pen C. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J. 2005;26:1653–1659. CrossRef
- Cooke CR, Joo MJ, Anderson SM, Lee TA, Udris EM, Johnson E, Au DH. The validity of using ICD-9 codes and pharmacy records to identify patients with chronic obstructive pulmonary disease. BMC Health Serv Res. 2011;11:37.
- Sharafkhaneh AP, Petersen N, Yu H, et al. Burden of COPD in a government health care system: a retrospective observational study using data from the US Veterans Affairs population. Int J Chron Obstruct Pulmon Dis. 2010;5:125–132.
- Rabe K, Hurd S, Anzueto A, Barnes P, Buist S, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–555. CrossRef
- Seemungal TA. Exacerbation rate, health status and mortality in COPD—a review of potential interventions. Int J Chron Obstruct Pulmon Dis. 2009;4:203–223. CrossRef
- Jochmann A, Neubauer F, Miedinger D, Schafroth TS, Chhajed PN, Tamm M, Leuppi J. General practitioners’ adherence to the COPD GOLD guidelines: baseline data from the Swiss COPD Cohort Study. Swiss Med Wkly. 2010;140:13053.
- Yip NH, Yuen G, Lazar EJ, Regan BK, Brinson MD, Taylor B, George L, Karbowitz SR, Stumacher R, Schluger NW, Thomashow BM. Analysis of hospitalizations for COPD exacerbation: opportunities for improving care. COPD. 2010;7:85–92. CrossRef
- Shen Y, Hendricks A, Zhang S, Kazis L. VHA enrollees’ health care coverage and use of care. Med Care Res Rev. 2003;60:253–267.
- Foster TS, Miller J, Marton JP, Caloyeras JP, Russell MW, Menzin J. Assessment of the economic burden of COPD in the US: a review and synthesis of the literature. COPD. 2006;3:177–178. CrossRef
- Missing Potential Opportunities to Reduce Repeat COPD Exacerbations
Journal of General Internal Medicine
Volume 28, Issue 5 , pp 652-659
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- inhaled medication use
- Industry Sectors
- Author Affiliations
- 3. Department of Pulmonary and Critical Care Medicine, University of Washington, 1959 N.E. Pacific, Campus Box 356522, Seattle, WA, 98195-6522, USA
- 1. Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- 2. Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA