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

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Citation: Respiratory Medicine. 108(9):1310-20, 2014 Sep.PMID: 25130680Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *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 SpecificityYear: 2014 ISSN:

0954-6111

Name of journal: Respiratory medicineAbstract: 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.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 All authors: Altan AE, Altman PR, Colice GL, Donohue JF, Hanania NA, Kurlander JL, Rodriguez-Roisin R, Sharafkhaneh AFiscal year: FY2015Digital Object Identifier:

http://dx.doi.org/10.1016/j.rmed.2014.07.002

Date added to catalog: 2016-01-13

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	25130680	Available		25130680

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.

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 S): 1,868 (standard deviation [SD], 3,910) versus 1,686 (SD, 2,707) for nebulized SABA only, 216 (SD, 0,710) versus 334 (SD, 4,853) for MDI SABA only, and 5,806 (SD, 5,260) versus 1,233 (SD, 7,006) for both nebulized and MDI SABA. IMPACTTM validated these findings.

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