COPD Outcomes Research Articles

Early diagnosis of COPD: myth or a true perspective.

The early stages of COPD have recently become a hot topic as many new risk factors have been proposed, but substantial knowledge gaps remain in explaining the natural history of the disease. If we are to modify the outcomes of COPD, early detection needs to play a critical role. However, we need to sort out the barriers to early detection and have a better understanding of the definition of COPD and its diagnosis and therapeutic strategies to identify and treat patients with COPD before structural changes progress. In this review, we aim to clarify the differences between early COPD, mild COPD and early detection of COPD, with an emphasis on the clinical burden and how different outcomes (quality of life, exacerbation, cost and mortality) are modified depending on which definition is used. We will summarise the evidence for the new multidimensional diagnostic approaches to detecting early pathophysiologic changes that potentially allow for future studies on COPD management strategies to halt or prevent disease development.

Early detection high-value approach to improving outcomes in COPD

Early detection high-value approach to improving outcomes in COPD

Maximum Voluntary Ventilation and Its Relationship With Clinical Outcomes in Subjects With COPD.

Previous studies have reported that maximum voluntary ventilation (MVV) may be better associated with commonly used outcomes in COPD than FEV1 and may provide information on respiratory mechanics. In this study, we aimed to investigate the relationship between MVV and clinical outcomes in COPD and to verify whether MVV predicts these outcomes better than FEV1. We conducted a cross-sectional study involving individuals with COPD. Lung function was assessed with spirometry; maximum inspiratory and expiratory pressures (PImax and PEmax, respectively) were assessed with manuvacuometry; and functional exercise capacity was assessed with the 6-min-walk test (6MWT). Dyspnea was assessed with the modified Medical Research Council (mMRC) scale; functional status was assessed with the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-m); and health status was assessed with the COPD Assessment Test (CAT). Correlations were verified with the Spearman coefficient, and stepwise multiple linear regression models investigated the predictors of clinical outcomes. Our study included 157 subjects: 82 males; median (interquartile range) age 66 (61-73) y; FEV1 46 (33-57) % predicted; 6MWT 86 (76-96) % predicted; PFSDQ-m total score 34 (14-57); and CAT total score 13 (7-19). Moderate correlations were found between MVV and PImax (r = 0.40), 6MWT (r = 0.50), mMRC (r = -0.56), and total scores on the PFSDQ-m (r = -0.40) and the CAT (r = -0.54). In the regression models, MVV was a predictor of almost all clinical outcomes, unlike FEV1. MVV correlates moderately with clinical outcomes commonly used in the evaluation of individuals with COPD, and MVV is a better predictor of respiratory muscle strength, functional exercise capacity, and patient-reported outcomes than FEV1.

0547 Insomnia in Veterans with COPD: Prevalence, Correlates, and Health Care Utilization

Abstract Introduction Veterans with COPD are a vulnerable group for developing insomnia. The objectives of this study were to examine the prevalence and correlates of insomnia and its impact on health care utilization in a national sample of Veterans with COPD. Methods National data from electronic medical records of Veterans who utilized the Veterans Health Administration between FY2011 and FY2017 was accessed from the Veterans Affair Corporate Data Warehouse. COPD was based on International Classification of Diseases diagnostic codes (ICD-9/10). Insomnia was defined by ICD-9/10 codes or sedative-hypnotic prescription of >30 doses in a given fiscal year. ICD-9/10 codes for other conditions were documented. Outpatient and inpatient health care service utilization included number of physician encounters and emergency room visits and hospitalizations with a primary diagnostic code for COPD or COPD exacerbation. Bivariate comparisons between veterans with COPD and insomnia and COPD only were made for sociodemographic, comorbidities, and health care utilization variables using t-tests and Chi-square tests, as appropriate. Results A total of 1,542,642 Veterans with COPD were identified during the 6-year period. Of those with COPD, 575,539 (37.3%) were identified as having insomnia. Veterans with COPD and comorbid insomnia were younger (64 years vs. 69 years) and more likely to be female (6.3% vs. 3.7%), Black (14.0% vs. 11.0%), be a current smoker (46.1% vs. 35.5%), and have comorbidities including obstructive sleep apnea, diabetes, asthma, stroke, depression, or posttraumatic stress disorder compared to those without insomnia (all p’s <0.001). Compared to Veterans with COPD only, those with comorbid insomnia had a greater number of COPD-related outpatient (6.9 vs. 10.5) and emergency room (1.1 vs. 1.2) visits and hospitalizations (1.9 vs. 2.3) (p’s <0.001). Conclusion Insomnia is highly prevalent in Veterans with COPD and is associated with greater COPD-related health care utilization. Future research is needed to determine if targeted treatment for insomnia can improve COPD outcomes. Support This study was funded by the VA Competitive Career Development Fund.

Environmental fungal sensitisation associates with poorer clinical outcomes in COPD.

IntroductionAllergic sensitisation to fungi such as Aspergillus are associated to poor clinical outcomes in asthma, bronchiectasis and cystic fibrosis; however, clinical relevance in COPD remains unclear.MethodsPatients with stable COPD (n=446) and nondiseased controls (n=51) were prospectively recruited across three countries (Singapore, Malaysia and Hong Kong) and screened against a comprehensive allergen panel including house dust mites, pollens, cockroach and fungi. For the first time, using a metagenomics approach, we assessed outdoor and indoor environmental allergen exposure in COPD. We identified key fungi in outdoor air and developed specific-IgE assays against the top culturable fungi, linking sensitisation responses to COPD outcomes. Indoor air and surface allergens were prospectively evaluated by metagenomics in the homes of 11 COPD patients and linked to clinical outcome.ResultsHigh frequencies of sensitisation to a broad range of allergens occur in COPD. Fungal sensitisation associates with frequent exacerbations, and unsupervised clustering reveals a “highly sensitised fungal predominant” subgroup demonstrating significant symptomatology, frequent exacerbations and poor lung function. Outdoor and indoor environments serve as important reservoirs of fungal allergen exposure in COPD and promote a sensitisation response to outdoor air fungi. Indoor (home) environments with high fungal allergens associate with greater COPD symptoms and poorer lung function, illustrating the importance of environmental exposures on clinical outcomes in COPD.ConclusionFungal sensitisation is prevalent in COPD and associates with frequent exacerbations representing a potential treatable trait. Outdoor and indoor (home) environments represent a key source of fungal allergen exposure, amenable to intervention, in “sensitised” COPD.

Impact of Radiographic Bronchiectasis in COPD

COPD and bronchiectasis frequently coexist, which creates an emerging phenotype with a worse prognosis. However, the impact of bronchiectasis on the natural history of COPD has not been fully evaluated and is still controversial. This meta-analysis was performed to clarify the associations of the presence of bronchiectasis with the prognosis and quality of life of patients with COPD. A systematic review and meta-analysis was performed following a search of medical databases, and included articles published up to April 2019. The following outcome measures were analyzed: age, sex, smoking history, body mass index, exacerbation rate, lung function, inflammatory biomarkers, albumin, colonization by potentially pathogenic microorganisms, Pseudomonas aeruginosa isolates, Haemophilus influenzae isolates, hospital admissions, and mortality. A total of 415,257 subjects with COPD from 18 observational studies were eligible; bronchiectasis was present in 25,929 subjects (6.24%). The coexistence of COPD and bronchiectasis occurred more often in older subjects with lower body mass index. The presence of bronchiectasis in the subjects with COPD increased the risk of daily sputum production (odds ratio [OR] 1.80, 95% CI 1.24-2.61), exacerbation (weighted mean difference [WMD] 0.72 times, 95% CI 0.59-0.85), frequent hospital admissions (WMD 0.35 times, 95% CI 0.21-0.49), and follow-up (>3 years) mortality (OR 2.26, 95% CI 0.95-5.36). The subjects with COPD and bronchiectasis showed poorer pulmonary function (FEV1/FVC: WMD -3.37%, 95% CI -5.63 to -1.11), lower albumin (Standardized mean difference [SMD] -0.17, 95% CI -0.26 to -0.08), elevated C-reactive protein (SMD 0.40, 95% CI 0.06-0.74), a greater proportion of chronic colonization by potentially pathogenic microorganisms (OR 6.65, 95% CI 4.44-9.95), and a higher isolation rate of P. aeruginosa (OR 5.13, 95% CI 4.89-5.38) or H. influenzae (OR 1.90, 95% CI 1.29-2.79) than the subjects with COPD without bronchiectasis. This meta-analysis confirmed the significant associations of the presence of bronchiectasis with the natural history, disease course, and outcomes in COPD. The COPD-bronchiectasis phenotype had adverse effects on subjects' health condition and prognosis.

Undiagnosed OSA May Significantly Affect Outcomes in Adults Admitted for COPD in an Inner-City Hospital

COPD is the second most common cause of hospital admission in the United States. OSA is a highly prevalent and underdiagnosed condition that may affect the outcome of COPD. We hypothesized that presence of unrecognized and untreated OSA will increase hospital readmissions in patients admitted for COPD exacerbation. We reviewed patients admitted for COPD exacerbation from May 2017 through July 2018 who were also screened for previously unrecognized and untreated OSA with a sleep questionnaire, and who subsequently underwent a high-resolution pulse oximetry or portable sleep monitoring study. We compared the rates of 30-, 90-, and 180-day readmission or death across OSA categories and compared overall survival in patients with and without OSA. Of 380 patients admitted for COPD exacerbation, 256 were screened for OSA with a sleep questionnaire (snoring, tiredness during daytime, observed apnea, high BP). Of these, 238 underwent an overnight high-resolution pulse oximetry/portable sleep monitoring. Of the 238 total patients, 111 (46.6%) were found to have OSA; 28.6%had mild, 9.7%moderate, and 8.4%severe OSA. Baseline characteristics and demographics were compared between the cohorts of participants with OSA and without OSA and were similar except that patients with OSA had a higher mean BMI (33.9 vs30.3kg/m2) and an increased prevalence of heart failure (19.8%vs7.1%). For patients with COPD and mild OSA, odds of 30-day readmission were 2.05 times higher than for patients without OSA (32.4%vs18.9%). Additionally, odds of 30-day readmission were 6.68 times higher for patients with moderate OSA vspatients without OSA (60.9%vs18.9%) and 10.01 times high for patients with severe OSA vspatients without OSA (70%vs18.9%). Readmission rates were also greater at 90 and 180days. All-cause mortality was lower for patients without OSA than for patients with OSA (P< .01). The time to hospital readmission or death was shorter with greater OSA severity (P< .01). Patients hospitalized for COPD exacerbation and who have unrecognized OSA; 30-, 90-, and 180-day readmission rates; and 6-month mortality rates are higher than in those without OSA.

Three-axis accelerometer system for comparison of gait parameters in children with cystic fibrosis and healthy peers

BackgroundCystic Fibrosis (CF), affecting functional exercise capacity generally measured by submaximal exercise test such as 6min walk test, is a progressive, autosomal recessive and metabolic disorder. Three-axis accelerometers, which are used during gait, are an easy way to assess gait parameters in patients and healthy individuals. Gait parameters were significantly associated with clinical outcomes of COPD. However, the association between gait parameters and clinical outcomes in children with CF is unclear. Research questionDo clinical outcomes in CF have an important role in determining gait parameters?. MethodsTwenty-one CF and 21 healthy subjects participated in this case-control study. Body composition was evaluated using Tanita-BC 418. Respiratory and knee extension muscle strengths were assessed. Functional exercise capacity was evaluated using the 6-min walk test (6MWT). Spatiotemporal gait parameters were evaluated using a validated wireless inertial sensing device (G-Sensor, BTS Bioengineering S.p.A., Italy) during the 6MWT and 7-meter gait test. ResultsMIP, the distance of 6MWT, and stride length were significantly lower in the CF group compare to healthy children (p<0.05). Gait speed and functional exercise capacity, cadence and functional exercise capacity, quadriceps muscle strength, FEV1, fat-free mass were found to be correlated in CF patients (p<0.05). SignificanceThe aerobic capacity and gait parameters were affected in CF patients with mild disease severity in our study. Clinical outcomes were associated with gait parameters in CF patients. This is the first study to use the 3-axis accelerometer to evaluate functional exercise capacity and gait parameters of CF and healthy children. A three-axis accelerometer can be used to assess functional exercise capacity and gait parameters in CF patients at the clinics.

STUDY OF NEUROLOGICAL MANIFESTATIONS OF DEFICIENCY OF VITAMIN B12

The purpose of this article is to study and provide an overview of the epidemiology, clinical presentation, disposition and outcome of COPD in India, which is one of the most affected countries in the world and contributes significantly to the morbidity and mortality of this disease, to the Emergency physicians as they are the front line force for diagnosing and managing all the emergencies in the hospital. Materials and methods: The current work represents a single institutional retrospective study on epidemiology, clinical presentation, disposition and outcome of COPD carried out in tertiary care teaching hospital, - 1 - Ahmedabad . The data was obtained from the record of 200 patients and reviewed and analysed from October-2017 to September-2019. Results: The data of 200 patients was collected from the record for this study. COPD was found more common in male and 5th- 6th decade. Smoking and tuberculosis were the major risk factors. COPD patients were most commonly presented with breathlessness, fever and cough. In the patients of COPD, emphysematous changes were found more commonly.

The Prevalence of Diabetes Mellitus in Chronic Obstructive Pulmonary Disease Patients

Backgrounds: Type 2 diabetes mellitus (DM) is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia still unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, morbidity and mortality.&#x0D; Methods: A cross sectional study was done in Asthma-COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty-four subjects were recruited. Interview, physical examination and laboratory testing were performed in all subjects. &#x0D; Results: A total of 64 patients with COPD (Males=60, Female=4) with mean age 65±8.7 were screened for DM. Patients with known history of DM were 12 subjects (18.8%) and were enrolled as known DM cases. Remaining 52 subjects (81.3%) whose DM status was unclear were screened by random or fasting blood sugar and HbA1c. Two subjects (3.1%) were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9%. Number of patients with pre-diabetes was 16 subjects (25%). There was no significant relationship between gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients. &#x0D; Conclusions: Prevalence of DM in COPD patients in the present study is 21.9%. It is important to screen all COPD patients for DM routinely. (J Respir Indo. 2020; 40(1): 48-57)

Per cent low attenuation volume and fractal dimension of low attenuation clusters on CT predict different long-term outcomes in COPD

BackgroundFractal dimension (D) characterises the size distribution of low attenuation clusters on CT and assesses the spatial heterogeneity of emphysema that per cent low attenuation volume (%LAV) cannot detect. This...

Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

The relationship between 25-hydroxyvitamin D (25-OH-vitamin D) and COPD outcomes remains unclear. Using the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), we determined associations among baseline 25-OH-vitamin D and cross-sectional and longitudinal lung function and COPD exacerbations. Serum 25-OH-vitamin D level was measured in stored samples from 1,609 SPIROMICS participants with COPD. 25-OH-vitamin D levels were modeled continuously and dichotomized as deficient (< 20ng/mL) vsnot deficient (≥ 20ng/mL). Outcomes of interest included %predicted FEV1 (current and 1-year longitudinal decline) and COPD exacerbations (separately any and severe, occurring in prior year and first year of follow-up). Vitamin D deficiency was present in 21%of the cohort and was more prevalent in the younger, active smokers, and blacks. Vitamin D deficiency was independently associated with lower %predicted FEV1 (by 4.11%) at enrollment (95%CI, -6.90%to -1.34%predicted FEV1; P= .004), 1.27%predicted greater rate of FEV1 decline after 1 year (95%CI, -2.32%to -0.22%predicted/y; P= .02), and higher odds of any COPD exacerbation in the prior year (OR, 1.32; 95%CI, 1.00-1.74; P= .049). Each 10-ng/mL decrease in 25-OH-vitamin D was associated with lower baseline lung function (-1.04%predicted; 95%CI, -1.96%to -0.12%predicted; P= .03) and increased odds of any exacerbation in the year before enrollment (OR, 1.11; 95%CI, 1.01-1.22; P= .04). Vitamin D deficiency is associated with worse cross-sectional and longitudinal lung function and increased odds of prior COPD exacerbations. These findings identify 25-OH-vitamin D levels as a potentially useful marker of adverse COPD-related outcomes.

REALizing and improving management of stable COPD in China: a multi-center, prospective, observational study to realize the current situation of COPD patients in China (REAL) \u2013 rationale, study design, and protocol

BackgroundChronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in China with a reported prevalence of 8.2% people aged ≥40 years. It is recommended that Chinese physicians follow Global Initiative for Chronic Obstructive Lung Disease (GOLD) and national guidelines, yet many patients with COPD in China remain undiagnosed. Furthermore, missed diagnoses and a lack of standardized diagnosis and treatment remain significant problems. The situation is further complicated by a lack of large-scale, long-term, prospective studies of real-world outcomes, including exacerbation rates, disease severity, efficacy of treatment, and compliance of COPD patients in China.Methods/designThe REALizing and improving management of stable COPD in China (REAL) study is a 52-week multi-center, prospective, observational trial. REAL aims to recruit approximately 5000 outpatients aged ≥40 years with a clinical diagnosis of COPD per GOLD 2016. Outpatients will be consecutively recruited from approximately 50 tertiary and secondary hospitals randomly selected across six geographic regions to provide a representative population. Patients will receive conventional medical care as determined by their treating physicians.The primary objective is to evaluate COPD patient outcomes including lung function, health status, exacerbations, hospitalization rate, and dyspnea following 1 year of current clinical practice. Secondary objectives are to assess disease severity, treatment patterns, adherence to medication, and associated risk factors. Data will be collected at two study visits, at patients’ usual care visits, and by telephone interview every 3 months.DiscussionKnowledge of COPD among physicians in China is poor. The REAL study will provide reliable information on COPD management, outcomes, and risk factors that may help improve the standard of care in China. Patient recruitment began on 30 June 2017 and the estimated primary completion date is 30 July 2019.Trial registrationClinicalTrials.gov identifier: NCT03131362. Registered on 20 March 2017.

Outcome of Patients Presented With Acute Exacerbation of Copd to Emergency Department of a Tertiary Care Hospital

The purpose of this article is to study and provide an overview of the epidemiology, clinical presentation, disposition and outcome of COPD in India, which is one of the most affected countries in the world and contributes significantly to the morbidity and mortality of this disease, to the Emergency physicians as they are the front line force for diagnosing and managing all the emergencies in the hospital. Materials and methods: The current work represents a single institutional retrospective study on epidemiology, clinical presentation, disposition and outcome of COPD carried out in tertiary care teaching hospital, - 1 - Ahmedabad . The data was obtained from the record of 200 patients and reviewed and analysed from October-2017 to September-2019. Results: The data of 200 patients was collected from the record for this study. COPD was found more common in male and 5th- 6th decade. Smoking and tuberculosis were the major risk factors. COPD patients were most commonly presented with breathlessness, fever and cough. In the patients of COPD, emphysematous changes were found more commonly.

Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

Impact of pulmonary rehabilitation programs in improving health status in COPD patients

Pulmonary rehabilitation programme (PRP) have a positive impact on multiple outcomes of COPD, such as decreasing symptoms, increasing exercise tolerance and improving general health status. The aim of this study is to evaluate exercise tolerance impairment and to assess the impact of PRP in improving health status in patients diagnosed with COPD. It was conducted a prospective parallel group study in the Pulmonary Rehabilitation Department of the Clinical Hospital "V. Babes”, Timisoara, from 2007 to 2010. The subjects included in the study were patients diagnosed with COPD stages I-IV GOLD, initially evaluated and started a PRP, then re-evaluated after 3 weeks and 6 months. The study group included 168 patients, 158 men, mean age 61.73 years. The initial evaluation revealed higher values of dyspnea scores using mMRC scale in advanced COPD stages (3.69±0.77 in patients with COPD stage IV, vs 0.88±0.5 in patients with COPD stage, p&lt;0.05), decreased Forced expiratory volume in 1 second (FEV1), PImax and PEmax, and 6 minutes walking distance values corresponding with COPD severity stages. Re-evaluation at 3 weeks and 6 months after the pulmonary rehabilitation programme was applied showed significant improved dyspnea scores and exercise tolerance. The results of this study reconfirmed the positive and persistent impact of pulmonary rehabilitation programme on muscle dysfunction, dyspnea, and quality of life in COPD patients, regardless of severity. Key words: COPD, pulmonary rehabilitation programme, 6 minutes walking test, pedometry,

Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive chronic condition. Improvements in therapies have resulted in better patient outcomes. The use of technology such as telemonitoring as an additional intervention...

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview.

Chronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular risk. The present narrative review considers the potential links between COPD and DM, such as systemic inflammation, oxidative stress, hypoxaemia and hyperglycaemia. The effects of antidiabetic drugs on lung function and COPD outcomes, as well as the possibility of common therapeutic modalities are also briefly considered. Further research is needed in this field to elucidate these relationships as well as their potential clinical implications in daily practice.

RESPONDERS TO A PHYSICAL ACTIVITY COACHING PROGRAM IN COPD

Rationale: Physical inactivity is associated with worse outcomes in COPD. There remains a critical gap regarding the real-world effectiveness of improving physical activity (PA) in large representative samples of older adults with COPD and its impact on hospitalizations. Methods: A pragmatic randomized trial was conducted to determine the effectiveness of a 12-month home-based physical activity coaching intervention (Walk On!, WO) compared to standard care (SC) in 2,707 patients at high risk for COPD exacerbations. The WO intervention included collaborative monitoring of steps, semi-automated step goal recommendations, individualized reinforcement, and peer/family support. This is a subgroup analysis of 321 patients who were randomized to WO and participated in the program, matched to SC patients based on their propensity scores (PS). Multivariate cox proportional hazards models were used to determine differences in all-cause hospitalizations in the 12-months following randomization. Results: WO patients with low PS (n=160) were matched to 888 low PS SC patients and 161 WO patients with high PS (n=161) were matched to 405 high PS SC patients. Characteristics of the cohort were: age: 72±10; 54% females; 74% Caucasian; FEV1% predicted: 61±23. WO-low PS patients had lower risk of all-cause hospitalizations compared to SC-low PS patients [HR:0.69, (95%CI, 0.50, 0.96), P=.03]. WO-high PS patients did not have significantly lower hospitalization risk compared to SC-high PS patients [HR:0.87, (95%CI, 0.64, 1.20), P=.40]. Conclusions: Patients with COPD who had a lower propensity to participate in the physical activity coaching intervention had lower hospitalization risks compared to those with a higher participation propensity.

Reduction in Hospital Readmission Rates Among Medicare Beneficiaries With Chronic Obstructive Pulmonary Disease: A Real-world Outcomes Study of Nebulized Bronchodilators

PurposeChronic obstructive pulmonary disease (COPD) is a common condition responsible for substantial morbidity, mortality, and costs in the United States. The economic burden of COPD is driven primarily by hospitalizations, with 1 in 5 hospitalized patients experiencing a 30-day readmission. Bronchodilators, delivered via handheld inhalers or nebulizers, are the mainstay of therapy for COPD. However, differences in outcomes between short- and long-acting therapies are unclear. We examined real-world differences in 30-day readmission and exacerbation rates between Medicare beneficiaries with COPD treated with a nebulized long-acting beta2-agonist (arformoterol tartrate [ARF]) and beneficiaries treated with a nebulized short-acting beta2-agonist (SABA) for maintenance therapy after hospital discharge. MethodsTruven MarketScan Hospital Drug Database and Medicare files were probabilistically matched between 2009 and 2013 to identify beneficiaries who were aged ≥65 years and discharged from a hospital with a primary COPD diagnosis or a secondary COPD diagnosis and a primary diagnosis for another respiratory condition. Matching was performed by using COPD hospitalization date (±7 days) and source, length of stay (±1 day), discharge date and destination, and hospital region. After applying additional inclusion/exclusion criteria, 2 cohorts were created: nebulized ARF users (n = 953) and nebulized SABA users (n = 6939). Logistic regression analyses were used to examine 30-day readmission (all-cause and COPD related) and exacerbation rates. Odds ratios (ORs), 95% CIs, and P values were computed. FindingsOn average, nebulized SABA users had more comorbidities than nebulized ARF users, including diabetes, atrial fibrillation, renal disease, musculoskeletal disease, myocardial infarction, and cognitive impairment (all, P < 0.0001). However, nebulized ARF users had a higher average COPD severity score than nebulized SABA users (49.5 v. 38.0; P < 0.001). COPD therapies at baseline were similar in both cohorts and included systemic corticosteroids (≥65%), short-acting bronchodilators (≥33%), and inhaled corticosteroids + long-acting beta2-agonists (30%). After adjusting for sociodemographic and hospital characteristics, concomitant medications, and case-mix, nebulized ARF users had 27% lower odds of an all-cause readmission (OR, 0.73; 95% CI, 0.59–0.92; P = 0.008) and 23% lower odds of a COPD-related readmission (OR, 0.77; 95% CI, 0.60–0.98; P = 0.032) at 30 days compared with users of a nebulized SABA. No difference was found in 30-day exacerbation rates between the cohorts. ImplicationsNebulized ARF users had lower 30-day readmission rates, greater COPD severity, and fewer comorbidities than nebulized SABA users. In this population, maintenance treatment with ARF reduced costly COPD outcomes.