Missing potential opportunities to reduce repeat COPD exacerbations

Anne C. Melzer, Laura M. Feemster, Jane E. Uman, David H. Ramenofsky, David H. Au

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)652-659
Number of pages8
JournalJournal of general internal medicine
Volume28
Issue number5
DOIs
StatePublished - May 2013

Bibliographical note

Funding Information:
Acknowledgments: This material is based upon work supported by the Department of Veterans Affairs, Health Services Research and Development (HSR&D), and American Lung Association grant CI-51755N. Dr. Cecere is supported by a VA HSR&D fellowship (TPM 61-037). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Dr. Au had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Keywords

  • Exacerbation
  • Inhaled medication use

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