Abstract：
BACKGROUND:A simple rule based on short-acting inhaled β2-agonist (SABA) use could identify patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbations and signal the need for maintenance therapy change, similar to asthma "Rules of Two(®)". METHODS:Associations between SABA use, COPD exacerbations, and health care costs over 1 year were examined retrospectively using de-identified patient data from the Optum Research Database (ORD; N = 56,581) and the Impact National Benchmark Database (IMPACT™; N = 9423). Nebulized and metered-dose inhaler (MDI) SABA doses were normalized to 2.5 mg and 90 mcg albuterol equivalents, respectively. RESULTS:The GOLD initiative establishes ≥2 exacerbations/year as indicative of increased risk in COPD. We identified a correlation (p < 0.0001) between 1.5 SABA doses/day and this frequency of exacerbations. In ORD, patients using ≥1.5 versus <1.5 SABA doses/day experienced significantly more exacerbations: 1.92 (95% confidence interval [CI], 1.89-1.96) versus 1.36 (95% CI, 1.34-1.38) per patient year (PPY). Above-threshold use was associated with higher average annual COPD-related costs (2010 $US): $21,868 (standard deviation [SD], $53,910) versus $11,686 (SD, $32,707) for nebulized SABA only, $9216 (SD, $30,710) versus $7334 (SD, $24,853) for MDI SABA only, and $15,806 (SD, $35,260) versus $11,233 (SD, $27,006) for both nebulized and MDI SABA. IMPACT™ validated these findings. CONCLUSION:Patients with COPD using ≥1.5 SABA doses/day were at increased risk of exacerbations. Our results suggest a "Rule of 3-2": SABA use ≥3 times in 2 days should be considered a clinical marker for needing treatment reevaluation.
journal_name
Respir Medjournal_title
Respiratory medicineauthors
Sharafkhaneh A,Altan AE,Colice GL,Hanania NA,Donohue JF,Kurlander JL,Rodriguez-Roisin R,Altman PRdoi
10.1016/j.rmed.2014.07.002subject
Has Abstractpub_date
2014-09-01 00:00:00pages
1310-20issue
9eissn
0954-6111issn
1532-3064pii
S0954-6111(14)00240-6journal_volume
108pub_type
杂志文章abstract：:Increased levels of exhaled nitric oxide (FeNO) and airway hyperresponsiveness (AHR) to inhaled mannitol are related to allergic inflammation characterized by eosinophil infiltration and a clinical response to treatment with anti-inflammatory agents in subjects with asthma. This study determines the diagnostic accurac...
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pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：1995-05-01 00:00:00
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pub_type： 杂志文章,随机对照试验
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pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：2006-06-01 00:00:00
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pub_type： 杂志文章
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更新日期：2006-09-01 00:00:00
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更新日期：2014-08-01 00:00:00
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更新日期：2018-11-01 00:00:00
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pub_type： 杂志文章,多中心研究,随机对照试验
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pub_type： 杂志文章,随机对照试验
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更新日期：2013-07-01 00:00:00
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pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：1990-09-01 00:00:00
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更新日期：1992-05-01 00:00:00
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更新日期：2016-06-01 00:00:00
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更新日期：1991-07-01 00:00:00
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更新日期：2007-01-01 00:00:00
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更新日期：2003-03-01 00:00:00
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更新日期：1993-01-01 00:00:00
