Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD

Raju Bishwakarma, Wei Zhang, Yong Fang Kuo, Gulshan Sharma

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. Methods: We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitaliza­tion. Primary outcome was the 30-day readmission rate between “users” and “nonusers” of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The “user” and “nonuser” groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%, P-value 0.11; 18.0% vs 17.8%, P-value 0.85, respectively). However, the “users” had higher rates of COPD-related ER visits (5.3% vs 3.4%, P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11–1.93) and readmission (7.8% vs 5.0%, P-value, 0.0001 and aOR 1.48 [95% CI, 1.18–1.86]) than “nonusers”. After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07–1.96) and that of readmission was 1.34 (95% CI, 1.04–1.73). The results were similar when restricted to patients hospitalized for AECOPD. Conclusion: Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospital­ized for COPD.

Original languageEnglish (US)
Pages (from-to)477-486
Number of pages10
JournalInternational Journal of COPD
Volume12
DOIs
StatePublished - Jan 31 2017

Fingerprint

Patient Readmission
Bronchodilator Agents
Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Hospital Emergency Service
Propensity Score
Odds Ratio
Medicare Part A
Medicare Part B
Medicare Part D
Muscarinic Antagonists
Medicare
Prescriptions
Hospitalization

Keywords

  • COPD
  • Long-acting bronchodilators
  • Medicare
  • Readmission

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

@article{e96bff27a8f84b0eb42aefcf95cb1dd2,
title = "Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD",
abstract = "Background: The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. Methods: We studied a 5{\%} sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitaliza­tion. Primary outcome was the 30-day readmission rate between “users” and “nonusers” of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8{\%}) used LABDs±ICSs during the specified period. The “user” and “nonuser” groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4{\%} vs 20.7{\%}, P-value 0.11; 18.0{\%} vs 17.8{\%}, P-value 0.85, respectively). However, the “users” had higher rates of COPD-related ER visits (5.3{\%} vs 3.4{\%}, P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95{\%} CI, 1.11–1.93) and readmission (7.8{\%} vs 5.0{\%}, P-value, 0.0001 and aOR 1.48 [95{\%} CI, 1.18–1.86]) than “nonusers”. After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95{\%} CI, 1.07–1.96) and that of readmission was 1.34 (95{\%} CI, 1.04–1.73). The results were similar when restricted to patients hospitalized for AECOPD. Conclusion: Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospital­ized for COPD.",
keywords = "COPD, Long-acting bronchodilators, Medicare, Readmission",
author = "Raju Bishwakarma and Wei Zhang and Kuo, {Yong Fang} and Gulshan Sharma",
year = "2017",
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day = "31",
doi = "10.2147/COPD.S122354",
language = "English (US)",
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pages = "477--486",
journal = "International Journal of COPD",
issn = "1176-9106",
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TY - JOUR

T1 - Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD

AU - Bishwakarma, Raju

AU - Zhang, Wei

AU - Kuo, Yong Fang

AU - Sharma, Gulshan

PY - 2017/1/31

Y1 - 2017/1/31

N2 - Background: The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. Methods: We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitaliza­tion. Primary outcome was the 30-day readmission rate between “users” and “nonusers” of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The “user” and “nonuser” groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%, P-value 0.11; 18.0% vs 17.8%, P-value 0.85, respectively). However, the “users” had higher rates of COPD-related ER visits (5.3% vs 3.4%, P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11–1.93) and readmission (7.8% vs 5.0%, P-value, 0.0001 and aOR 1.48 [95% CI, 1.18–1.86]) than “nonusers”. After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07–1.96) and that of readmission was 1.34 (95% CI, 1.04–1.73). The results were similar when restricted to patients hospitalized for AECOPD. Conclusion: Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospital­ized for COPD.

AB - Background: The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. Methods: We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitaliza­tion. Primary outcome was the 30-day readmission rate between “users” and “nonusers” of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The “user” and “nonuser” groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%, P-value 0.11; 18.0% vs 17.8%, P-value 0.85, respectively). However, the “users” had higher rates of COPD-related ER visits (5.3% vs 3.4%, P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11–1.93) and readmission (7.8% vs 5.0%, P-value, 0.0001 and aOR 1.48 [95% CI, 1.18–1.86]) than “nonusers”. After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07–1.96) and that of readmission was 1.34 (95% CI, 1.04–1.73). The results were similar when restricted to patients hospitalized for AECOPD. Conclusion: Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospital­ized for COPD.

KW - COPD

KW - Long-acting bronchodilators

KW - Medicare

KW - Readmission

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