title: Delivery of ipratropium and albuterol combination therapy for chronic obstructive pulmonary disease: effectiveness of a two-in-one inhaler versus separate inhalers.
abstract: OBJECTIVE
  To determine whether a combined formulation consisting of ipratropium and an inhaled beta2 agonist (2-in-1 therapy) leads to lower respiratory-related healthcare use and charges and improved compliance compared with treatment with separate ipratropium and beta2-agonist inhalers (separate inhaler therapy).
  
  
  METHODS
  Retrospective inception cohort study.
  
  
  METHODS
  Healthcare use, charges, and treatment compliance were examined for adults age 38 years or older who initiated ipratropium therapy on or after July 1997, based on health claims data for United Healthcare enrollees from 5 health plans from July 1997 through December 1998. A total of 428 patients received 2-in-1 therapy, and 658 patients received separate inhaler therapy. To adjust for disease severity and other confounders, the following were determined for the preinitiation period: age; sex; use of oral steroids, antibiotics, or albuterol; respiratory-related healthcare use; and respiratory diagnoses. Compliance was defined as not interrupting or discontinuing therapy during the follow-up period.
  
  
  RESULTS
  After adjusting for baseline covariates, 2-in-1 therapy users had a significantly lower risk of emergency department use or hospitalization (relative risk = 0.58, 95% confidence interval [CI] = 0.36, 0.94), lower mean monthly healthcare charges (P= .015), shorter hospital stays (2.05 vs 4.61 days, P = .040), and greater likelihood of compliance (odds ratio = 1.77, 95% CI = 1.46, 2.14).
  
  
  CONCLUSIONS
  A single inhaler containing both ipratropium and albuterol can increase compliance and decrease respiratory morbidity and charges over and above the effects achieved with separate inhalers for these 2 agents.
authors.affiliation: University of Iowa, Iowa City, USA. echrischilles@uiowa.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chrischilles
authors.forename: Daniel
authors.initials: D
authors.lastname: Gilden
authors.forename: Joanna
authors.initials: J
authors.lastname: Kubisiak
authors.forename: Linda
authors.initials: L
authors.lastname: Rubenstein
authors.forename: Hemal
authors.initials: H
authors.lastname: Shah
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol