title: Use of nebulized inhaled corticosteroids among older adult patients: an assessment of outcomes.
abstract: BACKGROUND
  Inhaled corticosteroids (ICSs) are used by patients of all ages, but older patients may have difficulty with conventional inhalation devices and therefore may benefit from the easy-to-use delivery mechanism of the nebulizer.
  
  
  OBJECTIVE
  To compare the outcomes, resource use, and health care costs of patients prescribed nebulized ICSs before and after treatment.
  
  
  METHODS
  All patients 50 years and older prescribed nebulized ICSs were identified from a nationally representative managed care claims database (1999-2003). Patients with 1 year of continuous enrollment were analyzed using a retrospective cohort design; outcomes, resource use, and costs were measured and compared 6 months before and 6 months after the initial nebulized ICS prescription.
  
  
  RESULTS
  A total of 2,178 patients were identified for participation in the study, of whom 668 were analyzed. Patients were prescribed nebulized ICSs primarily for asthma (57.4%) and chronic obstructive pulmonary disease (52.1%). Nebulized ICSs were prescribed mostly by primary care physicians and pulmonologists. More than 40% of patients used nebulized ICSs persistently (at least 1 refill); persistent users averaged 123.4 days of use during 6 months of follow-up. There was a significant decrease in systemic corticosteroid use among persistent users (48.0% vs 38.8%; odds ratio, 0.7; 95% confidence interval, 0.5-1.0; P = .03). There was an emergency department visit in 20.2% and 15.0% of persistent users before and after the index date, respectively (odds ratio, 0.7; 95% confidence interval, 0.45-1.09; P = .12); 20.5% and 17.5% were hospitalized before and after the index date, respectively (odds ratio, 0.8; 95% confidence interval, 0.54-1.27; P = .38). No significant difference occurred in total health care costs during follow-up compared with baseline.
  
  
  CONCLUSIONS
  In this retrospective cohort study, older patients who used nebulized ICSs persistently demonstrated fewer emergency department visits and systemic corticosteroid use than before nebulized ICS use. These improved outcomes were not associated with an increase in health care costs.
authors.affiliation: New York College of Osteopathic Medicine, Old Westbury, New York 11568-8000, USA. PMARCUS192@aol.com
authors.forename: Philip
authors.initials: P
authors.lastname: Marcus
authors.forename: Edward A
authors.initials: EA
authors.lastname: Oppenheimer
authors.forename: Pankaj A
authors.initials: PA
authors.lastname: Patel
authors.forename: Laura M
authors.initials: LM
authors.lastname: Katz
authors.forename: John J
authors.initials: JJ
authors.lastname: Doyle
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D019819:Budesonide / Q000008:administration & dosage* / Q000191:economics; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D019819:Budesonide