Journal of General Internal Medicine

, Volume 28, Issue 5, pp 652–659

Missing Potential Opportunities to Reduce Repeat COPD Exacerbations

Authors

    • Department of Pulmonary and Critical Care MedicineUniversity of Washington
  • Laura M. Feemster
    • Health Services Research and DevelopmentDepartment of Veterans Affairs Puget Sound Health Care System
    • Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Washington
  • Jane E. Uman
    • Health Services Research and DevelopmentDepartment of Veterans Affairs Puget Sound Health Care System
  • David H. Ramenofsky
    • Department of Pulmonary and Critical Care MedicineUniversity of Washington
  • David H. Au
    • Health Services Research and DevelopmentDepartment of Veterans Affairs Puget Sound Health Care System
    • Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Washington
Original Research

DOI: 10.1007/s11606-012-2276-1

Cite this article as:
Melzer, A.C., Feemster, L.M., Uman, J.E. et al. J GEN INTERN MED (2013) 28: 652. doi:10.1007/s11606-012-2276-1

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

Among patients treated for an exacerbation of COPD, we found relatively few were subsequently prescribed inhaled therapies known to reduce exacerbations.

KEY WORDS

COPDexacerbationinhaled medication use

Supplementary material

11606_2012_2276_MOESM1_ESM.docx (27 kb)
ESM 1(DOCX 26 kb)

Copyright information

© Society of General Internal Medicine 2012