Bronchodilators use in patients with COPD

Abstract

Background

Bronchodilators are commonly used as maintenance and rescue therapy in patients with COPD. We aimed to examine the prescribing patterns of bronchodilators in clinical practice.

Methods

We identified patients with COPD who initiated oral or inhaled bronchodilators between 2001 and 2010 from the Taiwan National Health Insurance Research Database. We followed the patients for 1 year. For bronchodilator prescriptions, we classified the treatments based on medication classes and regimens (oral bronchodilators alone, oral and inhaled bronchodilators in combination, or inhaled bronchodilators alone). For inhaled bronchodilator prescriptions, we further classified the treatments as short-acting bronchodilators alone, short-acting and long-acting bronchodilators in combination, and long-acting bronchodilators alone. We evaluated the prescribing patterns and the change with time, in different physician specialists, and in different hospital accreditation levels.

Results

Among a cohort of 4,387 study-eligible patients, we identified 21,235 bronchodilator prescriptions for the analysis. The majority of prescriptions were oral xanthines or beta-2 agonists (62.63% and 47.54%, respectively) rather than prescriptions for inhaled bronchodilators (less than 10%). Nearly 80% of prescriptions were oral bronchodilator alone regimens. Use of oral bronchodilators declined with time and varied with health care providers, which were most commonly prescribed by non-chest specialists and in primary care clinics. Despite limited use of inhaled bronchodilators, it was noted that short-acting bronchodilators alone regimens accounted for 60% of the inhaled bronchodilator prescriptions.

Conclusion

Excessive use of oral and short-acting bronchodilators is noted in general practice. Further research and education programs are warranted to decrease inadequate oral bronchodilators and optimize inhaled treatments in the management of patients with COPD.

Keywords:

• bronchodilators
• chronic obstructive pulmonary disease
• prescribing patterns Taiwan

Supplementary materials

Table S1 Anatomical Therapeutic Chemical (ATC) classification system codes used to identify bronchodilator initiators

Table S2 International Classification of Diseases, 9th Revision, Clinical modification (ICD-9-CM) diagnostic codes used to identify comorbidities among bronchodilator initiators at baseline

Table S3 Device types of inhaled bronchodilators over 1 year in total bronchodilator initiators and stratified by the years of index dates

Table S4 Use of bronchodilators and the association with hospitalization in the follow-up 1 year

Acknowledgments

This study was in part supported by the Taiwan Department of Health grant (DOH101-TD-B-111-01), which did not play any role in the study design, literature search, study selection, collection and analysis of data, interpretation of results, or drafting of the manuscript.

Author contributions

Study conception and design: YHD, CLH, CHC. Data acquisition: MSL. Data analysis and interpretation: YHD, CLH, YYL, CHC, MSL. Manuscript drafting: YHD, CLH. Critical manuscript revision: YYL, CHC, MSL. CHC is the guarantor of the paper, had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. All the authors have read, contributed to, and approved the final manuscript and agreed to transfer the copyright ownership in the event of acceptance. YHD and CLH contributed equally to this manuscript.

Disclosure

The authors report no conflicts of interest in this work.