Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States

Figures & data

Table 1 Demographic and clinical description of study sample during pre-index year

Characteristics	Total		Newly diagnosed		Previously diagnosed
					Maintenance-naïve		Maintenance-experienced
	N=55,361		N=21,314		N=15,688		N=18,359
Demographic
Age in years (mean, SD)	66.25	12.3	63.30	12.6	65.89	12.3	69.99	10.7
Age group in years (n, %)
40–64	27,986	50.6%	13,350	62.6%	8,577	54.7%	6,059	33.0%
≥65	27,375	49.4%	7,964	37.4%	7,111	45.3%	12,300	67.0%
Female (n, %)	29,829	53.9%	11,513	54.0%	8,551	54.5%	9,765	53.2%
Region (n, %)
Northeast	4,851	8.8%	1,990	9.3%	1,243	7.9%	1,618	8.8%
North Central	20,010	36.1%	7,176	33.7%	5,409	34.5%	7,425	40.4%
South	23,231	42.0%	9,441	44.3%	7,189	45.8%	6,601	36.0%
West	7,193	13.0%	2,671	12.5%	1,825	11.6%	2,697	14.7%
Unknown	76	0.1%	36	0.2%	22	0.1%	18	0.1%
Overall disease burden
CCI (mean, SD)	1.00	1.3	0.74	1.2	1.16	1.4	1.17	1.4
Asthma (n, %)	8,014	14.5%	1,449	6.8%	2,480	15.8%	4,085	22.3%
URTI (n, %)	9,852	17.8%	3,838	18.0%	3,072	19.6%	2,942	16.0%
LRTI (n, %)	11,184	20.2%	2,879	13.5%	3,643	23.2%	4,662	25.4%
CVD (n, %)	28,689	51.8%	9,504	44.6%	9,232	58.8%	9,953	54.2%
Depression (n, %)	5,203	9.4%	1,988	9.3%	1,774	11.3%	1,441	7.8%
# of unique Rx classes (mean, SD)	8.06	6.7	5.79	5.8	6.59	6.7	11.96	5.8
# of Rx (mean, SD)	8.96	7.6	6.26	6.5	7.16	7.5	13.63	6.8
# of unique 3-digit ICD-9 Dx codes (mean, SD)	10.22	7.1	8.79	6.9	11.57	7.4	10.72	7.0
Reliever medication use
SABA canister use (n, %)	13,362	24.1%	1,764	8.3%	2,429	15.5%	9,169	49.9%
OCS prescription use (n, %)	12,754	23.0%	2,364	11.1%	2,530	16.1%	7,860	42.8%
Nebulized IPR use (n, %)	2,574	4.6%	N/A	N/A	482	3.1%	2,092	11.4%

Abbreviations: CCI, Charlson comorbidity index; CVD, cardiovascular disease; Dx, diagnosis; ICD-9, International Classification of Diseases, 9th Revision; IPR, ipratropium or combination ipratropium–albuterol; LRTI, lower respiratory tract infection; N/A, not applicable; OCS, oral corticosteroid; Rx, prescription; SABA, short-acting beta agonist; SD, standard deviation; URTI, upper respiratory tract infection.

Table 2 Maintenance and reliever medication use patterns in COPD patients in 2008

	Total		Newly diagnosed		Previously diagnosed
					Maintenance-naïve		Maintenance-experienced
	N=55,361		N=21,314		N=15,688		N=18,359
Maintenance drug use	24,938	45.0%	5,598	26.3%	3,045	19.4%	16,295	88.8%
TIO	12,248	22.1%	2,232	10.5%	1,238	7.9%	8,778	47.8%
LABA	1,711	3.1%	158	0.7%	140	0.9%	1,413	7.7%
ICS	2,157	3.9%	438	2.1%	268	1.7%	1,451	7.9%
ICS + LABA	14,814	26.8%	3,017	14.2%	1,662	10.6%	10,135	55.2%
Inhaled IPR	7,129	12.9%	1,590	7.5%	760	4.8%	4,779	26.0%
Xanthines	1,704	3.1%	83	0.4%	96	0.6%	1,525	8.3%
Reliever drug use	38,172	69.0%	13,719	64.4%	8,574	54.7%	15,879	86.5%
SABA	18,647	33.7%	5,868	27.5%	3,395	21.6%	9,384	51.1%
OCS	17,457	31.5%	6,017	28.2%	3,331	21.2%	8,109	44.2%
Nebulized IPR	3,602	6.5%	776	3.6%	705	4.5%	2,121	11.6%
ABX	33,049	59.7%	12,365	58.0%	7,488	47.7%	13,196	71.9%

Abbreviations: ABX, respiratory antibiotics; COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; IPR, ipratropium or combination ipratropium–albuterol; LABA, long-acting beta agonist; OCS, oral corticosteroid; SABA, short-acting beta agonist; TIO, tiotropium.

Figure 1 Rates of pharmacotherapy in a prevalent COPD population by prior diagnosis and maintenance-treatment status.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2 Prevalence of treatment with long-acting maintenance pharmacotherapy in COPD patients with an exacerbation history in 2008*.

Note: *Excludes newly diagnosed patients by definition.
Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; ICS + LABA, combination of inhaled corticosteroid and long-acting beta-agonist; ICS-containing, any ICS or ICS + LABA; LABA, long-acting beta agonist; MTx, maintenance treatment; TIO, tiotropium.

Figure 3 Short-term treatment of acute exacerbations of COPD.

Notes: (A) After discharge from COPD-related hospitalization. (B) After discharge from COPD-related ED visit.
Abbreviations: ABX, antibiotics; COPD, chronic obstructive pulmonary disease; ED, emergency department; OCS, oral corticosteroid.