Xu Qingqing, Laxa Sarah S, Serna Omar, Sansgiry Sujit S
PhD candidate, College of Pharmacy, University of Houston, TX.
Independent Pharmacy Consultant, Houston.
Am Health Drug Benefits. 2020 Feb;13(1):32-42.
Several medications, including long-acting bronchodilators (LABDs), are critical to the management of chronic obstructive pulmonary disease (COPD). Clinical guidelines recommend the initiation of an LABD for COPD posthospitalization to prevent exacerbations. COPD can limit a patient's exercise tolerance, mobility, and ability to work. Disease exacerbations resulting from inadequate treatment have contributed to increased medical costs and morbidity.
To analyze the prescription fills for COPD medications, especially LABDs, before and after COPD-related hospitalization, in elderly patients, and to evaluate factors associated with prescription fills of LABDs after COPD-related hospitalization.
This retrospective cohort study included patients with COPD aged ≥65 years who enrolled in Cigna-HealthSpring Medicare Advantage plans in Texas between 2011 and 2014. The index hospitalization was the first hospitalization with a primary diagnosis of COPD. Based on prescription fills within 180 days of the postindex discharge date, eligible patients were divided into 4 groups, by types of medication used. Prescription fills were compared during the 180-day preindex admission and 180-day postindex discharge.
Of the 1352 patients included, 12% received LABDs and 26% received any COPD medication. The LABD group versus the no-LABD group and the COPD medication group versus the no-COPD medication group were more likely to have a higher Charlson Comorbidity Index (CCI) score. McNemar's tests indicated that the proportions of patients who filled any COPD medication prescription increased from before to after hospitalization. Overall, 69% of patients did not fill any COPD medication during the study period. Adjusted analysis indicated that patients with a higher CCI score who filled an LABD prescription or at least 1 other COPD medication within 180 days before hospitalization were more likely to fill an LABD prescription after hospitalization; filling an inhaled corticosteroid (ICS) prescription before hospitalization was associated with not filling an LABD prescription after hospitalization.
Although filling an LABD and other COPD medications increased after hospitalization, the overall prescription fills for LABDs according to clinical guidelines was low in elderly patients. Patients with COPD who underutilized LABDs for maintenance therapy and relied more on ICSs before hospitalization were less likely to fill a prescription for an LABD after hospitalization. Future studies should evaluate patients' reasons for medication underutilization.
包括长效支气管扩张剂（LABD）在内的几种药物对慢性阻塞性肺疾病（COPD）的管理至关重要。临床指南建议在COPD患者出院后开始使用LABD以预防病情加重。COPD会限制患者的运动耐量、活动能力和工作能力。治疗不足导致的疾病加重导致医疗成本和发病率增加。
分析老年患者COPD相关住院前后COPD药物尤其是LABD的处方配药情况，并评估与COPD相关住院后LABD处方配药相关的因素。
这项回顾性队列研究纳入了2011年至2014年期间在德克萨斯州参加信诺-健康春天医疗保险优势计划的≥65岁的COPD患者。索引住院是首次以COPD为主要诊断的住院。根据索引出院日期后180天内的处方配药情况，符合条件的患者按使用的药物类型分为4组。比较索引入院前180天和索引出院后180天的处方配药情况。
在纳入的1352名患者中，12%接受了LABD，26%接受了任何COPD药物。LABD组与非LABD组以及COPD药物组与非COPD药物组更有可能具有较高的Charlson合并症指数（CCI）评分。McNemar检验表明，开具任何COPD药物处方的患者比例从住院前到住院后有所增加。总体而言，69%的患者在研究期间未开具任何COPD药物。校正分析表明，住院前180天内开具LABD处方或至少1种其他COPD药物且CCI评分较高的患者住院后更有可能开具LABD处方；住院前开具吸入性糖皮质激素（ICS）处方与住院后未开具LABD处方相关。
虽然住院后LABD和其他COPD药物的处方配药有所增加，但老年患者中根据临床指南开具的LABD总体处方配药率较低。住院前未充分使用LABD进行维持治疗且更依赖ICS的COPD患者住院后开具LABD处方的可能性较小。未来的研究应评估患者药物使用不足的原因。
