000			03886nam a22005897a 4500
008			160113s20142014 xxu||||| |||| 00| 0 eng d
022			_a0954-6111
040			_aOvid MEDLINE(R)
099			_a25130680
245			_aA simple rule to identify patients with chronic obstructive pulmonary disease who may need treatment reevaluation.
251			_aRespiratory Medicine. 108(9):1310-20, 2014 Sep.
252			_aRespir Med. 108(9):1310-20, 2014 Sep.
253			_aRespiratory medicine
260			_c2014
260			_fFY2015
266			_d2016-01-13
520			_aBACKGROUND: 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()".
520			_aCONCLUSION: 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.
520			_aMETHODS: 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.
520			_aRESULTS: 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 _US): _21,868 (standard deviation [SD], _53,910) versus _11,686 (SD, _32,707) for nebulized SABA only, _9216 (SD, _30,710) versus _7334 (SD, _24,853) for MDI SABA only, and _15,806 (SD, _35,260) versus _11,233 (SD, _27,006) for both nebulized and MDI SABA. IMPACTTM validated these findings.
546			_aEnglish
650			_a*Adrenergic beta-2 Receptor Agonists/tu [Therapeutic Use]
650			_a*Pulmonary Disease, Chronic Obstructive/dt [Drug Therapy]
650			_aAdrenergic beta-2 Receptor Agonists/ad [Administration & Dosage]
650			_aAged
650			_aAlbuterol/ad [Administration & Dosage]
650			_aAlbuterol/tu [Therapeutic Use]
650			_aBronchodilator Agents/ad [Administration & Dosage]
650			_aBronchodilator Agents/tu [Therapeutic Use]
650			_aComorbidity
650			_aDatabases, Factual
650			_aDose-Response Relationship, Drug
650			_aDrug Administration Schedule
650			_aFemale
650			_aHealth Care Costs/sn [Statistics & Numerical Data]
650			_aHumans
650			_aMale
650			_aMetered Dose Inhalers
650			_aMiddle Aged
650			_aNebulizers and Vaporizers
650			_aPulmonary Disease, Chronic Obstructive/ec [Economics]
650			_aRetrospective Studies
650			_aSensitivity and Specificity
651			_aMedStar Washington Hospital Center
656			_aMedicine/Pulmonary-Critical Care
657			_aJournal Article
657			_aResearch Support, Non-U.S. Gov't
700			_aColice, Gene L
790			_aAltan AE, Altman PR, Colice GL, Donohue JF, Hanania NA, Kurlander JL, Rodriguez-Roisin R, Sharafkhaneh A
856			_uhttp://dx.doi.org/10.1016/j.rmed.2014.07.002 _zhttp://dx.doi.org/10.1016/j.rmed.2014.07.002
942			_cART _dArticle
999			_c1200 _d1200