title: Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD.
abstract: BACKGROUND
  The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown.
  
  
  METHODS
  We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitalization. Primary outcome was the 30-day readmission rate between "users" and "nonusers" of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The "user" and "nonuser" groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%,P-value 0.11; 18.0% vs 17.8%,P-value 0.85, respectively). However, the "users" had higher rates of COPD-related ER visits (5.3% vs 3.4%,P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11-1.93) and readmission (7.8% vs 5.0%,P-value <0.0001 and aOR 1.48 [95% CI, 1.18-1.86]) than "nonusers". After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07-1.96) and that of readmission was 1.34 (95% CI, 1.04-1.73). The results were similar when restricted to patients hospitalized for AECOPD.
  
  
  CONCLUSIONS
  Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospitalized for COPD.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine.
authors.forename: Raju
authors.initials: R
authors.lastname: Bishwakarma
authors.affiliation: Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Office of Biostatistics; Sealy Center of Aging, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine; Sealy Center of Aging, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Gulshan
authors.initials: G
authors.lastname: Sharma
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D018450:Disease Progression; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D016344:Medicare Part A; D016345:Medicare Part B; D054524:Medicare Part D; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D016017:Odds Ratio; D010359:Patient Readmission; D057216:Propensity Score; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
keywords: COPD; Medicare; long-acting bronchodilators; readmission