TREATMENT PATTERNS FOR PATIENTS HOSPITALIZED WITH THE DIAGNOSIS OF ASTHMA OR COPD EXACERBATION

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: The use of long-acting beta agonist (LABA) and long-acting muscarinic antagonist (LAMA) therapy in hospitalized patients with COPD and asthma may prove beneficial due to flatter peak/trough variation in lung function, fewer PRN rescue treatments and easier transition of care for patients. However, the cost of such inhalers has caused hospitals to substitute scheduled short-acting combination (SABD) bronchodilators in place of longer acting medications. COPD guidelines do not address the use of LABA/LAMA in hospitalized patients. Because of conflicting views (efficacy vs cost) we sought to understand our unique hospital's practice habits by determining the difference in scheduled PRN SABD treatments when LABA and/or LAMA was added. METHODS: Patients with the diagnosis of COPD or asthma for at least 12 months and who were hospitalized for an exacerbation were selected for this retrospective chart review. Sixty charts were randomly selected to review respiratory therapy treatments prescribed and administered. The first treatment counted began in the Emergency Department and ended at discharge or at the end of 7 days. The scheduled use of routine, separate or combination, SABA and/or SAMA treatment times given during waking hours, night time hours, and any as needed treatments were collected. LABA and/or LAMA and SABD, scheduled or PRN was recorded. Charts were also reviewed for comorbid conditions. RESULTS: Twenty-five (43%) of the 60 participants were men and the average age was 66 years (58.5,76). The most prevalent diagnosis was COPD (90%), followed by asthma (7%), and asthma + COPD (3%). Comorbidities included heart failure (20%), diabetes mellitus (15%), pneumonia (16%), and hypoxemia (7%). The rates of therapy were SABD (30%), LABA (70%), LAMA (42%). Overall, patients who received both LABA and LAMA had fewer short-acting treatments than those who did not receive either LABA or LAMA. Patients who received both LABA and LAMA had numerically fewer short-acting treatments than patients who did not receive LABA and LAMA; combination LABA/LAMA therapy was associated with a statistically significant reduction in SABD treatments (p=0.03). CONCLUSIONS: Prescribing practices for hospitalized COPD and asthma patients in a large, urban, academic, hospital are heterogeneous. At our hospital, the prescription of LABA/LAMA decreased the number of PRN SABD significantly. From a purely financial perspective, the auto-substitution of scheduled SABD is driven by labor and medication costs. From a health outcome perspective, a larger head-to-head trial is critically needed to help adjudicate questions of real financial cost, length of stay, and hospital readmissions as well as patient safety. CLINICAL IMPLICATIONS: This study implies that LABA/LAMA treatments prescribed for patients hospitalized with the diagnosis of COPD or asthma exacerbation may reduce the number of PRN SABD treatments. DISCLOSURES: Speaker/Speaker's Bureau relationship with Monaghan Medical Corporation Please note: $1-$1000 Added 11/19/2018 by Mary Hart, source=Web Response, value=travel Removed 03/11/2019 by Mary Hart, source=Web Response Advisory Committee Member relationship with AstraZeneca Please note: $1001 - $5000 Added 11/19/2018 by Mary Hart, source=Web Response, value=travel Speaker/Speaker's Bureau relationship with AstraZeneca Please note: $20001 - $100000 Added 03/13/2019 by Mark Millard, source=Web Response, value=Honoraria Research relationship with AstraZeneca Please note: >$100000 Added 03/13/2019 by Mark Millard, source=Web Response, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Boerhinger Ingleheim Please note: $5001 - $20000 Added 03/13/2019 by Mark Millard, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1001 - $5000 Added 03/13/2019 by Mark Millard, source=Web Response, value=Honoraria No relevant relationships by Kristen Tecson, source=Web Response