A simple rule to identify patients with chronic obstructive pulmonary disease who may need treatment reevaluation. - 2014

BACKGROUND: A simple rule based on short-acting inhaled beta2-agonist (SABA) use could identify patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbations and signal the need for maintenance therapy change, similar to asthma "Rules of Two". CONCLUSION: Patients with COPD using >1.5 SABA doses/day were at increased risk of exacerbations. Our results suggest a "Rule of 3-2": SABA use >3 times in 2 days should be considered a clinical marker for needing treatment reevaluation.Copyright � 2014. Published by Elsevier Ltd. METHODS: Associations between SABA use, COPD exacerbations, and health care costs over 1 year were examined retrospectively using de-identified patient data from the Optum Research Database (ORD; N = 56,581) and the Impact National Benchmark Database (IMPACTTM; N = 9423). Nebulized and metered-dose inhaler (MDI) SABA doses were normalized to 2.5 mg and 90 mcg albuterol equivalents, respectively. 2,707) for nebulized SABA only, 0,710) versus 5,260) versus RESULTS: The GOLD initiative establishes >2 exacerbations/year as indicative of increased risk in COPD. We identified a correlation (p < 0.0001) between 1.5 SABA doses/day and this frequency of exacerbations. In ORD, patients using >1.5 versus <1.5 SABA doses/day experienced significantly more exacerbations: 1.92 (95% confidence interval [CI], 1.89-1.96) versus 1.36 (95% CI, 1.34-1.38) per patient year (PPY). Above-threshold use was associated with higher average annual COPD-related costs (2010


English

0954-6111


*Adrenergic beta-2 Receptor Agonists/tu [Therapeutic Use]
*Pulmonary Disease, Chronic Obstructive/dt [Drug Therapy]
Adrenergic beta-2 Receptor Agonists/ad [Administration & Dosage]
Aged
Albuterol/ad [Administration & Dosage]
Albuterol/tu [Therapeutic Use]
Bronchodilator Agents/ad [Administration & Dosage]
Bronchodilator Agents/tu [Therapeutic Use]
Comorbidity
Databases, Factual
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Health Care Costs/sn [Statistics & Numerical Data]
Humans
Male
Metered Dose Inhalers
Middle Aged
Nebulizers and Vaporizers
Pulmonary Disease, Chronic Obstructive/ec [Economics]
Retrospective Studies
Sensitivity and Specificity


MedStar Washington Hospital Center


Medicine/Pulmonary-Critical Care


Journal Article
Research Support, Non-U.S. Gov't