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Introduction Chronic obstructive pulmonary disease (COPD) is
a debilitating disease that is asso-ciated with anincreased risk of death
COPD
The fifth leadingcause of death
worldwide in 2002
the
fourth leading
disease contributingto prematuremortality
Become the thirdleading cause of
death worldwide bythe
year 2030
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Chronic
cough
excessivesputum
production
wheeze. COPD
Therapy recommended ????
The 2014 Global initiative for chronicObstructive Lung Disease (GOLD)
guidelines recommmend
using inhaled long-acting bronchodi-lator (LABD) medications they areconvenient and are more effectivethan short-acting bronchodilator(SABD) medications
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Methods
Data were extracted from the Truven Health MarketScanCommercial and Medicare Supplemental Research Databases
This retrospective study ( 1 April 2008 31 Maret 2012)Data source
Patients who were at least 40 years old (commercial) or at least65 years old (Medicare supplemental),
Had a first hospitalization with COPD as the primary diagnosis
Enrolled 1 year before and 9 months after the index periodINCLUDED:
Diagnosed cystic fibrosis or tuberculosis at any time during thestudy period on a non-diagnostic claim
Transferred to another inpatient facility after hospital discharge
EXCLUDED:
For continuous variablesunivariate descriptive statistics
For independent sampleschi-square test
For correlated samples
McNemars
chi-square test
statistical
analyses
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RESULTS
Total patients met inclusion/exclusion criteria
All Patients with claims within the MarketScan
database during the index period
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Table1 Baseline patient characteristics and
resource utilization by 1180 days post-index
LABD prescription fills and overall
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Discussion Did not fill any LABD or SABD prescription in
the 90 days before or 180 days afterhospitalizationone quarter of theCOPD patients
Initiated an LABD following theirhospitalization
only approximately onequarter of the COPD
The pharmacological agents can reduce COPD exacerbation frequency and severity
It has also been shown that early treatment improves outcomes of COPD exacerbations and
leads to a faster recovery
Delay in medication initiation after an index hospitalization for COPD has been
associated with an increased risk of a subsequent COPD-related hospitalization or ED visit.
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The finding that patients in the no LABD group scored higher on thecomorbidity index than the LABD group
The finding that the no LABD group had fewer OP physician visits, EDvisits, and hospitalizations in the 1- to 90- and 1- to 180-day post-indexperiods than the LABD group
This finding might suggest that patients in the no LABD group had more
pressing health concerns that took precedence over control of COPDsymptoms
finding of this study worth noting was that patients who didnot fill an LABD prescription within the first 90 days afterhospitalization were not likely to fill an LABD prescription 91
180 days after hospitalization
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This research also had some limitations.
1. codes on the insurance claims might have beenrecorded incorrectly or not at all,
2. Disease severity, COPD stage, mortality rate, and otherclinical variables were unable to be recorded due to thenature of the database.
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Conclusion The observational study of claims dataa significant
proportion of COPD patients who were hospitalizedfor COPD were not receiving an LABD beforehospitalization, and, despite the negative impact ofhospitalization on long-term outcome
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