Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States.

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Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States.

Author(s): Gregory B Diette ¹ , Anand A Dalal ² , Anna O D'Souza ³ , Orsolya E Lunacsek ³ , Saurabh P Nagar ²

Publication date (Electronic): 2015

Journal: International journal of chronic obstructive pulmonary disease

Publisher: Informa UK Limited

Keywords: COPD, exacerbations, maintenance treatment, pharmacotherapy

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Abstract

This study evaluated patterns of pharmacotherapy in chronic obstructive pulmonary disease (COPD) as they relate to recommended guidelines in a prevalent COPD patient population with employer-sponsored health insurance in the US.

Most cited references 13

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Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study.

N R Anthonisen, J Connett, J. Kiley … (1994)

To determine whether a program incorporating smoking intervention and use of an inhaled bronchodilator can slow the rate of decline in forced expiratory volume in 1 second (FEV1) in smokers aged 35 to 60 years who have mild obstructive pulmonary disease. Randomized clinical trial. Participants randomized with equal probability to one of the following groups: (1) smoking intervention plus bronchodilator, (2) smoking intervention plus placebo, or (3) no intervention. Ten clinical centers in the United States and Canada. A total of 5887 male and female smokers, aged 35 to 60 years, with spirometric signs of early chronic obstructive pulmonary disease. Smoking intervention: intensive 12-session smoking cessation program combining behavior modification and use of nicotine gum, with continuing 5-year maintenance program to minimize relapse. Bronchodilator: ipratropium bromide prescribed three times daily (two puffs per time) from a metered-dose inhaler. Rate of change and cumulative change in FEV1 over a 5-year period. Participants in the two smoking intervention groups showed significantly smaller declines in FEV1 than did those in the control group. Most of this difference occurred during the first year following entry into the study and was attributable to smoking cessation, with those who achieved sustained smoking cessation experiencing the largest benefit. The small noncumulative benefit associated with use of the active bronchodilator vanished after the bronchodilator was discontinued at the end of the study. An aggressive smoking intervention program significantly reduces the age-related decline in FEV1 in middle-aged smokers with mild airways obstruction. Use of an inhaled anticholinergic bronchodilator results in a relatively small improvement in FEV1 that appears to be reversed after the drug is discontinued. Use of the bronchodilator did not influence the long-term decline of FEV1.

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Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease

R. Pauwels, S Buist, P. CALVERLEY … (2001)

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Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.

John Benjamin, Shan Gao, Peter K Lindenauer … (2006)

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is 1 of the 10 leading causes of hospitalization among adults in the United States. To evaluate the quality of care provided to patients hospitalized for acute exacerbations of COPD and to determine whether hospital or patient characteristics influence treatment. Retrospective cohort study. 360 hospitals throughout the United States. 69,820 patients hospitalized for acute exacerbations of COPD. Adherence to diagnosis and treatment recommendations contained in guidelines produced by the American College of Physicians and the American College of Chest Physicians; analyses of associations between hospital and patient characteristics and composite measures of performance. Of the 69,820 patients, 66,276 (95%) underwent chest radiography, 63,715 (91%) received supplemental oxygen, 67 515 (97%) received bronchodilators, 59,240 (85%) received systemic steroids, and 59,053 (85%) were given antibiotics. In total, 45,800 (66%) received this entire set of recommended care processes. Numerous participants received tests or treatments that were not beneficial: 16,607 (24%) were treated with methylxanthine bronchodilators, 10,051 (14%) had sputum testing, 8354 (12%) underwent acute spirometry, 4299 (6%) had chest physiotherapy, and 1409 (2%) were treated with mucolytic medications. Overall, 31,519 patients (45%) received at least 1 of these nonrecommended care elements, and 22,929 (33%) received ideal care, defined as all of the recommended care processes and none of the nonrecommended ones. Individual hospital performance varied widely; whereas older patients and women were more likely to receive ideal care than their counterparts, a higher annual volume of admissions for COPD was not associated with improved hospital performance. The study used administrative data, not chart review, and was limited to the inpatient management of COPD. The quality of care for patients hospitalized for acute exacerbations of COPD may be improved by increasing the use of systemic corticosteroid and antibiotic therapy, decreasing the use of unnecessary and potentially harmful treatments, and reducing variation in practice across hospitals.