title: The association between inhaled long-acting bronchodilators and less in-hospital care in newly-diagnosed COPD patients.
abstract: BACKGROUND
  Although the efficacy of inhaled long-acting bronchodilators has been well documented in randomised controlled studies, whether similar effects are obtained in real-life clinical practice is not clear. In this study, we analysed the effect of inhaled long-acting bronchodilators in newly-diagnosed COPD patients.
  
  
  METHODS
  The Korean Health Insurance Review and Assessment Service databases were used. Participants ≥40-years-old who had not been diagnosed with COPD between 2007 and 2008 but were diagnosed and prescribed COPD medication in 2009 were designated as newly-diagnosed COPD patients. Patients were divided into three groups based on the use of bronchodilators, an inhaled long-acting bronchodilator (LA-B), an inhaled short-acting bronchodilator (SA-B) and an oral medication (OM) group.
  
  
  RESULTS
  A total of 77,480 newly-diagnosed COPD patients with a mean age of 68.5 years, among which 43,530 (56.2%) were men, were included in the study. ER visits and hospitalisation were associated with SA-B group, male gender, older age, Medicaid coverage, tertiary healthcare centre visits and higher comorbidities. Multivariate analysis showed that the SA-B group was associated with more ER visits, recurrent ER visits, hospitalisation and recurrent hospitalisation (adjusted ORs [95% confidence intervals] = 4.32 [3.93-4.75], 6.19 [5.24-7.30], 5.04 [2.95-3.39], and 8.49 [7.67-9.39], respectively) compared with the LA-B group. Medical utilisation cost was also higher in the SA-B group.
  
  
  CONCLUSIONS
  Inhaled long-acting bronchodilator use was associated with lower rates of hospitalisation, fewer ER visits and lower medical costs in newly-diagnosed COPD patients in real-life clinical practice.
authors.affiliation: Office of Health Services Research, National Evidence-based Healthcare Collaborating Agency, Republic of Korea.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Research Support, National Strategic Coordinating Center for Clinical Research, Republic of Korea.
authors.forename: Kyungjoo
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Research Support, National Strategic Coordinating Center for Clinical Research, Republic of Korea.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Republic of Korea.
authors.forename: Kwang-Ha
authors.initials: KH
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Seoul St. Mary's Hospital, Republic of Korea.
authors.forename: Chin Kook
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yeouido St. Mary's Hospital, Republic of Korea.
authors.forename: Hyoung Kyu
authors.initials: HK
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Republic of Korea.
authors.forename: Young Sam
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Republic of Korea.
authors.forename: Young Bum
authors.initials: YB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Women's University, Seoul, Republic of Korea.
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors.forename: Yeon-Mok
authors.initials: YM
authors.lastname: Oh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors.forename: Sang-Do
authors.initials: SD
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea. Electronic address: iseiwon@gmail.com.
authors.forename: Sei Won
authors.initials: SW
authors.lastname: Lee
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000420:Albuterol / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012602:Scopolamine Derivatives / Q000627:therapeutic use; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D012602:Scopolamine Derivatives; D000420:Albuterol
keywords: Chronic obstructive pulmonary disease; Long-acting bronchodilator; Medical cost; Medical utilisation