title: Missing potential opportunities to reduce repeat COPD exacerbations.
abstract: BACKGROUND
  Long-acting beta-agonists (LABA) and/or inhaled corticosteroids (ICS) have been shown to reduce COPD exacerbation risk. Using data from a large integrated health-care system, we sought to examine whether these medication classes were initiated after an exacerbation of COPD.
  
  
  METHODS
  We identified patients who experienced an inpatient or outpatient COPD exacerbation within the Veterans Affairs Integrated Service Network (VISN)-20. We assessed the addition of a new inhaled therapy (an ICS, LABA or both) within 180 days after the exacerbation. We assessed independent predictors of adding treatment using logistic regression.
  
  
  RESULTS
  We identified 45,780 patients with COPD, of whom 2,760 patients experienced an exacerbation of COPD. Of these individuals, 2,570 (93.1 %) were on either none or only one long-acting medication studied (LABA or ICS). In the subsequent 180-day period after their exacerbation, only 875 (34.1 %) patients had at least one of these additional therapies dispensed from a VA pharmacy. Among patients who were treated in the outpatient setting, older age [OR 0.98/year, 95 % CI (0.97-0.99)], current tobacco use [OR 0.74, 95 % CI (0.60-0.90)], greater use of ipratropium bromide [OR 0.97/canister, 95 % CI (0.96-0.98)], prior COPD exacerbation [OR 0.55, 95 % CI (0.46-0.67)], depression [OR 0.77, 95 % CI (0.61-0.98)], CHF [OR 0.74, 95 % CI (0.57-0.97)], and diabetes (OR 0.77 (0.60-0.99)] were associated with lower odds of additional therapy. Patients who were treated in the hospital had similar associated predictors.
  
  
  CONCLUSIONS
  Among patients treated for an exacerbation of COPD, we found relatively few were subsequently prescribed inhaled therapies known to reduce exacerbations.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Washington, 1959 N.E. Pacific, Campus Box 356522, Seattle, WA 98195-6522, USA. acmelzer@u.washington.edu
authors.forename: Anne C
authors.initials: AC
authors.lastname: Melzer
authors.forename: Laura M
authors.initials: LM
authors.lastname: Feemster
authors.forename: Jane E
authors.initials: JE
authors.lastname: Uman
authors.forename: David H
authors.initials: DH
authors.lastname: Ramenofsky
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control*; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D000318:Adrenergic beta-Agonists; D005938:Glucocorticoids