The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Eberechukwu Onukwugha1, C. Daniel Mullins1, Sylvain DeLisle2; 1University of Maryland School of Pharmacy, Baltimore, MD; 2University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD

Background: Among patients with chronic obstructive pulmonary disease (COPD), there is increasing use of combination therapy, particularly among patients who are not controlled on monotherapy. We examine the clinical and demographic characteristics that influence recipient of tiotropium plus long-acting beta2-agonists (T+LABA) in a naturalistic setting among veterans with COPD, with particular attention to severity of disease. Methods: Electronic medical records from the Veterans Affairs (VA) Maryland Health Care System for the period 2005 to 2008 were analyzed. Inclusion criteria: 1) filled prescription for T or LABA between 2005 and 2007; 2) pulmonary function test (PFT) results; 3) PFT-based evidence of COPD. Disease severity and medication use within the first 6 months following the first filled prescription were identified via chart review. Bivariate statistics and multivariable logistic regression models were used to identify clinical and demographic predictors of T+LABA. Sensitivity analysis explored a revised definition of combination therapy that included the use of two or more of the following: inhaled corticosteroids (ICS), T and LABA. Results: The 838 PFT-confirmed COPD patients on T and/or LABA had the following characteristics: 95% male; 58% non-Hispanic White; age < 55 (N=137), age 55-64 (N=230), age 65-74 (N=231), age 75+ (N=240); mild COPD (7%), moderate (36%), severe (42%) and very severe (15%); T only (7%), LABA only (82%), T + LABA (11%). The utilization of monotherapy (T only or LABA only) versus combination therapy varied by disease stage (p < 0.0001): Mild, 100% vs. 0%; Moderate, 95% vs. 5%; Severe, 85% vs. 15%; Very severe, 78% vs. 22%. In multivariable analysis, the adjusted odds of receipt of T+LABA for patients with severe/very severe disease was 5 times (AOR: 4.99, 95% CI: 2.77-9.03, p < 0.001) that of patients with moderate disease. Other measures (e.g. age, race/ethnicity, smoker status, marital status) were not statistically significantly associated with receipt of T+LABA. Results were unchanged using the broader definition of combination therapy to include ICS. Conclusion: In a cohort of veterans with PFT-proven COPD, we find that one tenth of the sample uses T+LABA while the majority receives LABA alone. Additionally, disease severity rather than demographic measures is the primary predictor of receipt of multiple medications compared to T or LABA alone among veterans with COPD. Sponsored Research - Study is funded by Novartis.