Prescription Practices for Chronic Obstructive Pulmonary Disease: Findings from the National Ambulatory Medical Care Survey 1999–2010

Figures & data

Table 1.  Medications used in the treatment of chronic obstructive pulmonary disease and groupings of medications used in this study's analyses

Broader grouping	Grouping by class	Medications
Short-acting agents	Short-acting beta-2 agonists (SABA)	Albuterol, epinephrine, fenoterol, isoproterenol, isoetharine, levalbuterol, metaprotenerol, pirbuterol, terbutaline
	Short-acting anticholinergic agent	Ipratropium
	Combinations of short-acting agents	Albuterol/ ipratropium, fenoterol/ipratropium
	Methylxanthines	Aminophylline, dyphylline, theophylline
	Any short-acting agent	Albuterol, epinephrine, fenoterol, isoproterenol, isoetharine, levalbuterol, metaprotenerol, pirbuterol, terbutaline, ipratropium, albuterol/ipratropium, fenoterol/ipratropium, aminophylline, dyphylline, theophylline
Long-acting agents	Long-acting beta-2 agonists (LABA) prescribed as single products	Arformoterol, formoterol, salmeterol
	Inhaled corticosteroids (ICS) prescribed as single products	Beclomethasone, budenoside, ciclesonide, flunisolide, fluticasone, triamcinolone
	Combinations of LABAs and ICS	Formoterol/budesonide, formoterol /mometasone, salmeterol/fluticasone
	Any long-acting beta-2 agonists	Arformoterol, formoterol, salmeterol, formoterol/budesonide, formoterol /mometasone, salmeterol/fluticasone
	Any inhaled corticosteroids	Beclomethasone, budenoside, ciclesonide, flunisolide, fluticasone, triamcinolone, formoterol/budesonide, formoterol /mometasone, salmeterol/fluticasone
	Long-acting anticholinergic agent	Tiotropium
Any agent		All of above

Table 2.  Demographic characteristics of patients with chronic obstructive pulmonary disease aged ≥40 years, National Ambulatory Care Medical Survey 1999–2010

	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	P
Unweighted number of office visits	304	277	293	456	299	333	333	455	394	360	442	405
Weighted number of office visits (rounded to nearest thousand)	14,783,000	11,867,000	17,199,000	21,358,000	15,279,000	16,395,000	19,411,000	18,686,000	14,983,000	15,110,000	19,132,000	18,478,000
Age (year)	64.9 (1.0)	66.5 (1.0)	66.3 (1.0)	65.7 (1.0)	64.6 (0.9)	65.9 (0.9)	66.5 (1.0)	66.2 (0.8)	65.8 (1.1)	66.1 (0.9)	66.1 (0.9)	67.9 (1.0)	0.157
Men,%	43.7 (3.3)	50.4 (3.8)	48.4 (4.3)	40.7 (2.4)	48.3 (3.6)	44.2 (4.2)	44.6 (3.1)	47.7 (3.9)	43.4 (3.3)	39.7 (3.5)	43.1 (3.2)	49.9 (2.9)	0.568
White,%	88.6 (2.3)	90.8 (2.4)	92.6 (2.1)	89.4 (5.1)	88.2 (3.3)	86.4 (2.5)	96.6 (1.1)	88.7 (2.7)	87.5 (2.5)	90.2 (2.2)	87.3 (3.0)	83.8 (3.2)	0.141

Figure 1. Unadjusted percentage (95% standard error) of patients with chronic obstructive pulmonary disease aged ≥40 years who were prescribed major groups of medications used to treat chronic obstructive pulmonary disease, by year, National Ambulatory Medical Care Survey 1999–2010.

Table 3.  Percent (standard error) of office visits of patients with chronic obstructive pulmonary disease aged ≥ 40 years who were prescribed a medication used to treat chronic obstructive pulmonary disease, by year, National Ambulatory Care Medical Survey 1999–2010

Medications	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	P
N*	304	277	293	456	299	333	333	455	394	360	442	405
SABA	17.6 (2.6)	16.2 (2.9)	18.0 (3.2)	13.5 (4.2)†	14.1 (2.7)	16.0 (2.5)	19.1 (3.1)	21.9 (2.8)	21.3 (3.4)	26.4 (2.8)	22.1 (2.4)	24.7 (2.8)	<0.001
Ipratropium	4.0 (1.1)	—‡	—‡	5.6 (1.4)	5.2 (1.5)	7.6 (2.1)	4.8 (1.4)	5.4 (1.9)†	3.7 (1.2)†	2.7 (1.1)†	—‡	1.7 (0.6)†	0.008
SABA + ipratropium	4.7 (1.8)†	—‡	6.5 (1.9)	9.6 (1.7)	9.6 (2.5)	10.6 (2.1)	8.9 (2.0)	8.8 (2.2)	7.9 (1.6)	7.5 (1.7)	7.8 (2.5)†	8.0 (1.9)	0.070
Methylxanthines	4.7 (1.4)	5.5 (1.8)†	5.6 (1.7)†	3.3 (1.1)†	4.3 (1.0)	2.6 (1.0)†	—‡	—‡	—‡	—‡	—‡	—‡	0.001
Any short-acting medication	23.8 (3.4)	22.7 (3.5)	25.9 (4.1)	26.2 (3.7)	25.9 (3.9)	28.6 (3.5)	29.6 (3.8)	32.1 (4.4)	29.5 (3.2)	32.7 (3.0)	29.8 (3.3)	31.9 (3.4)	0.004
LABA	6.2 (2.0)	4.2 (1.4)	7.8 (2.2)	4.1 (1.2)	5.0 (1.4)	—‡	1.9 (0.8)†	—‡	—‡	—‡	—‡	2.2 (0.8)†	<0.001
ICS	10.9 (2.5)	9.4 (2.6)	10.9 (2.7)	7.8 (1.8)	7.4 (1.7)	2.6 (0.9)†	6.2 (1.5)	5.0 (1.4)	4.9 (1.6)†	5.8 (1.5)	4.5 (1.3)	4.4 (1.6)†	0.001
LABA + ICS	0.0 (0.0)	0.0 (0.0)	6.2 (2.4)†	4.3 (1.1)	13.8 (3.1)	17.6 (3.3)	14.9 (2.9)	15.7 (2.9)	15.7 (4.0)	19.8 (3.1)	18.9 (3.2)	26.7 (3.6)	<0.001
Any LABA	6.2 (2.0)†	4.2 (1.4)†	12.5 (2.6)	8.5 (1.7)	18.9 (3.4)	20.6 (3.8)	16.1 (3.0)	17.2 (3.0)	17.4 (3.9)	21.9 (2.9)	20.3 (3.2)	28.3 (3.8)	<0.001
Any ICS	10.9 (2.5)	9.4 (2.6)	16.3 (3.3)	12.1 (2.1)	20.9 (3.8)	20.1 (3.5)	21.1 (3.1)	20.3 (3.0)	19.8 (4.4)	24.4 (3.3)	23.4 (3.8)	30.9 (3.9)	<0.001
Tiotropium	0.0	0.0	0.0	0.0	0.0	—‡	6.3 (2.1)†	12.3 (3.1)	11.4 (1.9)	13.3 (2.3)	11.4 (2.4)	17.2 (3.2)	<0.001
Any long-acting medication	11.8 (2.6)	11.7 (2.7)	19.4 (3.3)	14.9 (2.1)	23.5 (4.0)	25.7 (4.9)	24.8 (3.5)	26.0 (3.3)	24.8 (3.9)	31.5 (3.2)	28.5 (3.7)	37.2 (4.3)	<0.001
Any COPD medication	27.0 (3.6)	27.5 (4.2)	36.5 (4.3)	33.0 (4.4)	36.3 (4.6)	40.0 (4.6)	40.0 (4.2)	41.7 (4.7)	41.1 (4.5)	48.0 (3.7)	42.5 (4.0)	49.1 (4.5)	<0.001

COPD ???????? chronic obstructive pulmonary disease; ICS ???????? inhaled corticosteroids; LABA ???????? long-acting beta-2 agonists; SABA ???????? short-acting beta-2 agonists.

??????????????Unweighted sample size.

†RSE ????30% to 40%.

‡RSE ????40%.

Table 4.  Percent (standard error) of office visits of patients with chronic obstructive pulmonary disease aged ????40 years who were prescribed a medication used to treat chronic obstructive pulmonary disease, by year, National Ambulatory Care Medical Survey 1999–2010. Patients with asthma were excluded

Medications	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	P
N*	292	270	289	440	289	329	325	449	388	351	431	398
SABA	17.2 (2.6)	14.0 (2.7)	17.4 (3.2)	10.9 (2.8)	13.5 (2.7)	16.2 (2.6)	18.9 (3.1)	21.8 (2.8)	20.7 (3.5)	25.9 (2.7)	21.8 (2.4)	24.0 (2.8)	<0.001
Ipratropium	4.2 (1.2)	—‡	—‡	5.8 (1.4)	5.1 (1.6)†	7.2 (2.2)†	4.9 (1.4)	5.4 (1.9)†	3.8 (1.2)†	2.8 (1.1)†	—‡	1.7 (0.6)†	0.008
SABA + ipratropium	4.9 (1.8)†	—‡	6.2 (2.0)†	9.8 (1.7)	9.6 (2.5)	10.8 (2.1)	8.4 (2.0)	9.0 (2.2)	8.0 (1.6)	7.7 (1.8)	8.0 (2.5)†	8.0 (2.0)	0.076
Methylxanthines	4.5 (1.4)†	5.7 (1.9)†	5.7 (1.8)†	3.5 (1.1)†	4.5 (1.1)	2.6 (1.0)†	—‡	—‡	—‡	—‡	—‡	—‡	0.001
Any short-acting medication	23.3 (3.4)	20.8 (3.4)	25.5 (4.0)	23.9 (2.8)	25.1 (4.0)	28.6 (3.5)	28.6 (3.8)	32.1 (4.4)	29.1 (3.3)	32.3 (2.9)	29.6 (3.4)	31.3 (3.4)	0.001
LABA	6.5 (2.1)†	4.3 (1.4)†	7.2 (2.0)	4.3 (1.4)†	5.2 (1.5)	—‡	2.0 (0.8)†	—‡	—‡	—‡	—‡	2.3 (0.9)†	<0.001
ICS	10.4 (2.6)	8.4 (2.5)†	11.1 (2.8)	7.7 (1.8)	6.9 (1.7)	2.6 (1.0)†	6.3 (1.5)	5.1 (1.4)	4.8 (1.6)†	5.0 (1.5)	4.4 (1.3)†	4.5 (1.6)†	0.001
LABA + ICS	0.0 (0.0)	0.0 (0.0)	5.5 (2.1)†	3.8 (1.1)	13.7 (3.0)	17.9 (3.4)	14.0 (2.9)	15.8 (3.0)	16.1 (4.1)	20.0 (3.1)	18.6 (3.3)	26.0 (3.6)	<0.001
Any LABA	6.5 (2.1)†	4.3 (1.4)†	12.0 (2.5)	8.1 (1.9)	18.9 (3.3)	21.0 (3.9)	15.3 (3.0)	17.4 (3.0)	17.8 (4.0)	22.2 (2.9)	20.1 (3.3)	27.6 (3.8)	<0.001
Any ICS	10.4 (2.6)	8.4 (2.5)†	15.9 (3.2)	11.5 (2.1)	20.2 (3.7)	20.5 (3.6)	20.3 (3.1)	20.5 (3.0)	20.1 (4.4)	23.8 (3.3)	23.0 (3.9)	30.2 (3.9)	<0.001
Tiotropium	0.0 (0.0)	0.0 (0.0)	0.0 (0.0)	0.0 (0.0)	0.0 (0.0)	—‡	6.0 (2.1)†	12.5 (3.1)	11.7 (2.0)	13.4 (2.3)	11.4 (2.5)	17.4 (3.2)	<0.001
Any long-acting medication	11.4 (2.6)	10.8 (2.7)	19.1 (3.3)	14.4 (2.2)	22.8 (3.9)	26.1 (5.1)	24.2 (3.5)	26.3 (3.3)	25.1 (4.0)	31.0 (3.2)	28.3 (3.9)	36.6 (4.4)	<0.001
Any COPD medication	26.6 (3.7)	25.4 (4.1)	35.6 (4.2)	30.8 (3.5)	35.3 (4.5)	40.2 (4.7)	39.0 (4.2)	41.7 (4.8)	41.0 (4.7)	47.7 (3.7)	41.9 (4.2)	48.2 (4.5)	<0.001

COPD ???????? chronic obstructive pulmonary disease; ICS ???????? inhaled corticosteroids; LABA ???????? long-acting beta-2 agonists; SABA ???????? short-acting beta-2 agonists.

??????????????Unweighted sample size.

†RSE ????30% to 40%.

‡RSE ????40%.

Figure 2. Percentage (95% confidence interval) of office visits among patients aged ≥40 years with chronic obstructive pulmonary disease listing respiratory symptoms as one of three reasons for the visit, by gender and year, National Ambulatory Medical Care Survey 1999–2010.

Table 5.  Unadjusted percent (standard error) of office visits of patients with chronic obstructive pulmonary disease aged ≥40 years who were prescribed a medication used to treat chronic obstructive pulmonary disease, by respiratory symptom status and survey period, National Ambulatory Care Medical Survey 1999–2010

	Respiratory symptoms				No respiratory symptoms				p-values for comparisons by respiratory symptom status
Medications	1999–2002	2003–2006	2007–2010	P trend	1999–2002	2003–2006	2007–2010	P trend	1999–2002	2003–2006	2007–2010
N*	603	565	584		727	855	1017
SABA	15.6 (2.3)	17.5 (2.0)	22.0 (2.3)	0.049	16.6 (2.3)	18.4 (1.7)	24.6 (1.7)	0.005	0.722	0.677	0.363
Ipratropium	5.4 (1.6)	4.4 (1.1)	2.5 (0.7)	0.100	5.6 (1.1)	6.6 (1.2)	2.1 (0.6)	0.006	0.909	0.157	0.639
SABA + ipratropium	7.7 (1.5)	8.3 (1.5)	5.1 (1.3)	0.180	5.2 (1.0)	10.2 (1.5)	9.5 (1.4)	0.012	0.144	0.364	0.019
SABA + ICS
Xanthines	4.4 (1.1)	1.8 (0.6)†	2.8 (1.1)†	0.282	4.9 (0.9)	3.6 (0.8)	—‡	0.000	0.707	0.084	0.042
Any short-acting medication	25.3 (2.4)	27.9 (2.5)	27.3 (2.8)	0.574	24.7 (2.5)	30.1 (2.6)	33.2 (2.0)	0.008	0.855	0.481	0.086
LABA	4.0 (1.2)	1.6 (0.6)†	2.3 (0.8)†	0.245	7.0 (1.2)	3.6 (0.8)	2.0 (0.5)	<0.001	0.059	0.040	0.682
ICS	7.7 (1.5)	4.0 (0.9)	4.8 (1.1)	0.116	11.2 (1.6)	6.3 (1.0)	4.9 (0.8)	<0.001	0.073	0.080	0.908
LABA + ICS	3.2 (1.0)	15.0 (2.2)	18.4 (3.1)	<0.001	2.9 (0.9)†	15.8 (1.7)	21.9 (1.9)	<0.001	0.782	0.725	0.325
Any LABA	6.8 (1.5)	16.6 (2.2)	20.3 (3.2)	<0.001	9.5 (1.4)	19.1 (1.9)	23.4 (1.9)	<0.001	0.179	0.298	0.394
Any ICS	10.5 (1.7)	18.8 (2.4)	22.6 (3.4)	0.001	14.1 (1.7)	21.9 (1.8)	26.3 (2.0)	<0.001	0.081	0.214	0.303
Tiotropium	0.00	7.1 (1.8)	11.2 (1.9)	<0.001	0.00	5.1 (1.0)	14.8 (1.6)	<0.001	—	0.211	0.122
Any long-acting medication	13.0 (1.7)	23.6 (2.8)	27.4 (3.5)	<0.001	16.4 (1.8)	26.1 (1.9)	32.8 (2.1)	<0.001	0.145	0.345	0.167
Any COPD medication	30.5 (2.7)	39.0 (3.0)	40.3 (3.7)	0.031	32.5 (2.7)	40.1 (2.7)	48.4 (2.3)	<0.001	0.505	0.749	0.051

COPD ???????? chronic obstructive pulmonary disease; ICS ???????? inhaled corticosteroids; LABA ???????? long-acting beta-2 agonists; SABA ???????? short-acting beta-2 agonists.

??????????????Unweighted sample size.

†RSE ????30% to 40%.

‡RSE ????40%.