Initial Treatment Regimen and Risk of Hospitalization in Patients with Chronic Obstructive Pulmonary Disease

Figures & data

Table 1.  Baseline Demographics by Treatment Regimen

	IPR	ICS	LABA	ICS + LABA	ICS + IPR
Patients, n	1754	1032	266	207	357
Mean age, y (± SD)	63.6 (10.9)	61.9 (11.3)	62.0 (11.4)	62.1 (11.1)	62.0 (10.9)
Female	52.2%	59.3%	54.9%	59.9%	52.9%
% Pulmonologist	12.4%	10.7%	16.9%	17.4%	18.5%
Oral steroids	29.0%	30.5%	29.3%	34.3%	41.6%
SABA	49.0%	73.2%	47.4%	60.9%	64.4%
Respiratory hosp	17.4%	15.0%	16.9%	16.9%	20.4%
Comorbid diagnoses
Asthma	20.6%	42.8%	36.8%	54.6%	41.5%
Acute bronchitis	32.3%	37.1%	38.7%	32.4%	35.6%
URTI	18.1%	23.2%	17.3%	23.7%	17.1%
Pneumonia	25.8%	21.6%	23.7%	19.3%	29.7%
Diabetes	17.9%	16.9%	15.0%	15.9%	17.7%
Coronary artery disease	24.3%	19.5%	22.6%	18.8%	25.2%
Hypertension	55.1%	48.6%	54.9%	50.7%	51.0%
Hyperlipidemia	35.4%	37.2%	40.6%	34.8%	37.0%

Baseline is defined as a 12‐month period prior to the first prescription for each treatment cohort.

ICS = Inhaled corticosteroid; IPR = Ipratropium; LABA = Long‐acting beta agonist; SABA = Short‐acting beta agonist; URTI = Upper respiratory tract infection.

^†Percent of patients with at least one claim in the prior 12 months (excludes COPD).

^‡Percent of patients with first recorded COPD diagnosis being made by a pulmonologist.

*p < 0.01 vs. ipratropium.

Table 2.  Adjusted Risk of Various COPD Treatment Regimens on COPD and All‐Respiratory Hospitalizations.

Treatment regimen	COPD hospitalizations		All respiratory hospitalizations
	Hazard ratio	95% CI	Hazard ratio	95% CI
IPR	1.0		1.0
ICS	0.643	0.512–0.808	0.710	0.610–0.826
LABA	0.796	0.555–1.141	0.832	0.654–1.057
ICS + LABA	0.533	0.328–0.865	0.641	0.479–0.856
ICS + IPR	1.038	0.787–1.370	0.935	0.768–1.138

CI = Confidence interval; ICS = Inhaled corticosteroid; IPR = Ipratropium; LABA = Long‐acting beta agonist.

*All hazard ratios were adjusted for age, gender, acute bronchitis or other lung disorder diagnosis at baseline, history of any previous hospitalization for respiratory condition, managed care plan, use of oral steroids prior to initial prescription claim, and physician specialty associated with index COPD diagnosis.

^†All respiratory related is defined as COPD and non‐COPD related (ICD‐9 460.xx to 521.xx).

Figure 1. Adjusted probability of COPD hospitalization‐free survival in patients with chronic obstructive pulmonary disease by treatment cohort. (Full color version available online.)

Figure 2. Adjusted probability of respiratory hospitalization‐free survival in patients with chronic obstructive pulmonary disease by treatment cohort. (Full color version available online.)

Table 3.  Adjusted Risk of Various COPD Treatment Regimens on COPD and All Respiratory Hospitalizations (Impact of Additional Exclusion Criteria on Statistically Significant Comparisons in Overall Analysis)

Treatment regimen	N	COPD hospitalizations			All respiratory hospitalizations
		n	Hazard ratio	95% CI	n	Hazard ratio	95% CI
Patients with hospitalization < 60 days excluded
IPR	1469	127 (8.7%)	1.0	Reference	285 (19.4%)	1.0	Reference
ICS	901	56 (6.2%)	0.658	0.474–0.915	143 (15.9%)	0.679	0.548–0.839
ICS + LABA	187	13 (7.0%)	0.746	0.415–1.342	32 (17.1%)	0.669	0.459–0.975
Patients with hospitalization < 90 days excluded
IPR	1426	112 (8.0%)	1.0	Reference	242 (17.0%)	1.0	Reference
ICS	863	40 (4.6%)	0.560	0.385–0.816	105 (12.2%)	0.600	0.471–0.764
ICS + LABA	184	13 (7.1%)	0.863	0.476–1.562	29 (15.8%)	0.727	0.489–1.082
Patients with hospitalization < 180 days excluded
IPR	1331	64 (4.8%)	1.0	Reference	147 (11.1%)	1.0	Reference
ICS	816	22 (2.7%)	0.557	0.336–0.923	58 (7.1%)	0.577	0.419–0.795
ICS + LABA	173	6 (3.5%)	0.721	0.306–1.699	18 (10.4%)	0.806	0.486–1.3336

CI = Confidence interval; ICS = Inhaled corticosteroids; IPR = Ipratropium/combivent; LABA = Long‐acting beta agonist.

^†All respiratory related is defined as COPD and non‐COPD related (ICD‐9 460.xx to 521.xx).

^‡n = crude # of events.

*All hazard ratios were adjusted for age, gender, acute bronchitis or other lung disorder diagnosis at baseline, history of any previous hospitalization for respiratory condition, managed care plan, use of oral steroids prior to initial prescription claim, and physician specialty associated with index COPD diagnosis. For each regimen, the reference regimen was ipratropium only as initial therapy.