Prescription Patterns of New Use of Fixed-Dose Combination Inhalers in Patients with Chronic Obstructive Pulmonary Disease: Long-Acting β2 Agonists Plus Long-Acting Muscarinic Antagonists versus Long-Acting β2 Agonists Plus Inhaled Corticosteroids

Figures & data

Figure 1 Flow chart of the study population assembly.

Abbreviations: COPD, chronic obstructive pulmonary disease; FDC, fixed-dose combination; ICS, inhaled corticosteroids; LABA, long-acting beta2-agonists; LAMA, long-acting muscarinic antagonists.

Figure 2 Temporal trends for use of LABA/LAMA FDC and LABA/ICS FDC.

Abbreviations: FDC, fixed-dose combination; ICS, inhaled corticosteroids; LABA, long-acting beta2-agonists; LAMA, long-acting muscarinic antagonists.

Figure 3 Healthcare provider characteristics for use of LABA/LAMA FDC and LABA/ICS FDC. (A) Hospital accreditation levels^a. (B) Physician specialties.

Notes: ^aThere were 133 LABA/LAMA FDC initiators and 820 LABA/ICS FDC initiators with missing information on hospital accreditation levels.

Abbreviations: FDC, fixed-dose combination; ICS, inhaled corticosteroids; LABA, long-acting beta2-agonists; LAMA, long-acting muscarinic antagonists.

Table 1 Demographics, Comorbidities, and Medication Use of LABA/LAMA FDC and LABA/ICS FDC Initiators

Variables^a	LABA/LAMA FDC (n=4019)	LABA/ICS FDC (n=8436)	Standardized Difference	Multivariate OR (95% CI)
Demographics
Age on index date, mean (SD)	71.16 (11.44)	67.83 (12.90)	0.273	1.019 (1.015–1.022)
Male	3445 (85.72)	4968(58.89)	0.628	3.61 (3.26–4.01)
Comorbidities
Hypertension	2207 (54.91)	4639 (54.99)	−0.002	0.87 (0.76–0.98)
Ischemic heart disease	1042 (25.93)	1908 (22.62)	0.077	1.10 (0.99–1.23)
Myocardial infarction	114 (2.84)	174 (2.06)	0.050	1.08 (0.82–1.43)
Coronary revascularization	83 (2.07)	142 (1.68)	0.029	0.98 (0.71–1.35)
Cardiac dysrhythmia	572 (14.23)	1094 (12.97)	0.037	0.98 (0.86–1.11)
Congestive heart failure	587 (14.61)	1194 (14.15)	0.013	1.01 (0.88–1.15)
Peripheral vascular disease	101 (2.51)	149 (1.77)	0.051	1.30 (0.98–1.72)
Hyperlipidemia	1100 (27.37)	2516 (29.82)	−0.054	1.01 (0.92–1.11)
Diabetes mellitus	973 (24.21)	2117 (25.09)	−0.020	0.95 (0.85–1.06)
Asthma	386 (9.60)	2143 (25.40)	−0.425	0.36 (0.32–0.40)
Pneumonia	1304 (32.45)	2577 (30.55)	0.041	1.05 (0.95–1.16)
Any cancer except lung cancer	449 (11.17)	663 (7.86)	0.113	1.18 (1.00–1.40)
Lung cancer	232 (5.77)	217 (2.57)	0.161	2.02 (1.62–2.53)
Depressive disorder	250 (6.22)	668 (7.92)	−0.066	0.98 (0.82–1.17)
Anxiety disorder	401 (9.98)	878 (10.41)	−0.014	1.21 (1.05–1.39)
Psychotic disorder	194 (4.83)	360 (4.27)	0.027	1.07 (0.88–1.32)
Bipolar disorder	49 (1.22)	138 (1.64)	−0.035	0.95 (0.66–1.38)
Charlson comorbidity score	2.87 (2.18)	2.64 (1.91)	0.112	1.00 (0.97–1.03)
Resource utilization
Number of outpatient visits in the past 365 days
≥4	3981 (99.05)^b	8379 (99.32)^b	−0.030	0.62 (0.31–1.23)
3	22 (0.55)^b	37 (0.44)^b	0.016	0.67 (0.28–1.59)
1 or 2	16 (0.40)^b	20 (0.24)^b	0.028	Ref
Number of hospital admissions in the past 365 days
≥2	648 (16.12)^b	1198 (14.20)^b	0.054	1.02 (0.86–1.21)
1	985 (24.51)^b	1802 (21.36)^b	0.075	1.10 (0.97–1.24)
0	2386 (59.37)^b	5436 (64.44)^b	−0.105	Ref
Number of outpatient visits due to COPD in the past 365 days
≥2	3024 (75.24)^b	5436 (64.44)^b	0.237	2.89 (2.00–4.18)
1	953 (23.71)^b	2805 (33.25)^b	−0.213	1.98 (1.36–2.89)
0	42 (1.05)^b	195 (2.31)^b	−0.098	Ref
Number of hospital admissions due to COPD in the past 365 days
≥2	191 (4.75)^b	275 (3.26)^b	0.076	1.14 (0.89–1.45)
1	640 (15.92)^b	961 (11.39)^b	0.132	1.24 (1.07–1.44)
0	3188 (79.32)^b	7200 (85.35)^b	−0.159	Ref
Number of outpatient visits due to CV disease^c in the past 365 days
≥2	2530 (62.95)^b	5122 (60.72)^b	0.046	1.05 (0.90–1.22)
1	198 (4.93)^b	388 (4.60)^b	0.015	1.08 (0.87–1.33)
0	1291 (32.12)^b	2926 (34.68)^b	−0.054	Ref
Number of hospital admissions due to CV disease^c in the past 365 days
≥2	846 (21.05)^b	1738 (20.60)^b	0.011	0.85 (0.75–0.97)
1	771 (19.18)^b	1416 (16.79)^b	0.062	1.00 (0.89–1.12)
0	2402 (59.77)^b	5282 (62.61)^b	−0.058	Ref

Notes: ^aData are demonstrated as number (n) and percentage (%) of patients unless otherwise specified. ^bPercentage of patients may be more or less than 100% due to rounding. ^cCV disease includes hypertension, ischemic heart disease, myocardial infarction, coronary revascularization, cardiac dysrhythmia, congestive heart failure, cerebrovascular disease, and peripheral vascular disease.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; CV, cardiovascular; FDC, fixed-dose combination; ICS, inhaled corticosteroids; LABA, long-acting beta2-agonists; LAMA, long-acting muscarinic antagonists; OR, odds ratio.