title: Bronchodilator reliever use and its association with the economic and humanistic burden of COPD: a propensity-matched study.
abstract: OBJECTIVE
  Short-acting bronchodilators are normally used as supplemental relief medication for breakthrough symptoms in COPD patients. The objective of this cross-sectional study was to assess if more frequent vs infrequent use of relief medication in maintenance-treated COPD patients, split by the severity dyspnea, was associated with an increase in the overall disease burden.
  
  
  METHODS
  A population-based cross-sectional survey (Adelphi DSP) was conducted among patients with COPD in five European countries. Information was collected on demographic and clinical characteristics, reliever inhaler use, dyspnea (mMRC), health status (CAT, EQ-5D), sleep quality (JSEQ) and healthcare resource use including moderate-severe COPD exacerbations, physician visits, COPD medications and other COPD related resources. The humanistic and economic burden was compared between patients with infrequent reliever use (<1 occasion/week) and more frequent use (≥ 1 occasion/week). The association between increased reliever use and economic burden was also examined after matching patients based on propensity-scores balancing demographic and disease burden characteristics.
  
  
  RESULTS
  Among the 1373 COPD patients prescribed a reliever inhaler, 29% reported using reliever medication ≥1 occasion/week. In the unmatched cohort, more frequent reliever use (n = 377) compared to infrequent use (n = 996) was linked to poorer health status (CAT: 25.7 vs 20.0; p < .0001; EQ-5D-3L: 0.63 vs 0.82; p < .0001) and poorer sleep quality (JSEQ: 8.6 vs 4.6 units; p < .0001). More frequent reliever use was also associated with higher annual rates of moderate/severe exacerbations (1.6 vs 1.0 events/year; p < .0001) and respiratory specialist visits (2.8 vs 2.2 events/year; p = .0001). In the propensity-score matched population, more frequent reliever use was also associated with significantly higher annual costs for COPD management (€5,034 vs €3,705, p = .0327) compared to patients with infrequent reliever use.
  
  
  CONCLUSIONS
  In moderate-to-severe COPD, more frequent reliever use is associated with increased exacerbation risk and increased management costs.
authors: a Value Evidence and Outcomes , GlaxoSmithKline R&D , Brentford , UK.
authors: Yogesh Suresh
authors: YS
authors: Punekar
authors: b Respiratory Medical, GlaxoSmithKline , Brentford , UK.
authors: Ian
authors: I
authors: Naya
authors: c Adelphi Real World , Macclesfield , UK.
authors: Mark
authors: M
authors: Small
authors: c Adelphi Real World , Macclesfield , UK.
authors: Tim
authors: T
authors: Holbrook
authors: c Adelphi Real World , Macclesfield , UK.
authors: Robert
authors: R
authors: Wood
authors: d Worldwide Epidemiology, GlaxoSmithKline R&D , Uxbridge , UK.
authors: Hana
authors: H
authors: Mullerova
authors: e Pneumology Department , Hospital Universitario Puerta de Hierro , Majadahonda , Madrid , Spain.
authors: Manuel
authors: M
authors: Valle
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; Costs; Dyspnea; Reliever use; Resource use