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Inhaler Prescription Pattern in Patients Over 90 Years of Age with Physician Diagnosed COPD in Inner City Chicago
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A5000 - Inhaler Prescription Pattern in Patients Over 90 Years of Age with Physician Diagnosed COPD in Inner City Chicago
Author Block: M. Tole1, I. Rubinstein2; 1Pulmonary, Chicago, IL, United States, 2Univ of Illinois At Chicago, Chicago, IL, United States.
Rationale: There are many unmet needs for the advanced elderly in healthcare today. In our prior effort we described the disease pattern in COPD patients diagnosed by GOLD criteria. We now seek to expand this population to all physician diagnosed COPD patients in inner city Chicago and better describe the inhaler prescription pattern.
Methods: Medical records were reviewed of nonagenarians with physician diagnosed COPD at Jesse Brown VA Medical Center in Chicago, IL. When PFTs were available they were used to confirm the diagnosis of COPD based on GOLD criteria and to describe COPD severity based on FEV1. Smoking history, prescribed COPD medication and hospitalizations for COPD exacerbations in the preceding two years were recorded. Additionally the presence of Asthma, obstructive sleep apnea, coronary artery disease, congestive heart failure, diabetes and neoplasms was assessed.
Results: A total of 150 patients (147 male and 3 female) older than 90 years of age were included. A substantial smoking history was confirmed on 106 (70%) of the cohort. Pulmonary function testing was available for 88 (59%). And of those patients 64 (43%) had evidence of obstructive lung disease based on GOLD criteria of FEV1/FVC ratio of 70%. Short acting beta agonists were prescribed for 124 patients (86%). Muscarinic agents were available to 83 patients (56%). Long acting beta agonists (n:73) and inhaled corticosteroids (n:76) were available to nearly half the patients. Supplemental oxygen was prescribed in 34 patients (23%). Extensive tobacco use was documented in 106 patients (71%) of this cohort. Obstructive sleep apnea is noted in 17 patients (11%) and Congestive heart failure was seen in 48 patients (32%). Coronary artery disease was the most common comorbidity, seen in 73 patients (49%). Inhaler prescription rates did not differ in the patients with PFT evidence of obstructive lung disease.
Conclusion: Amongst the patients that carry a diagnosis of COPD less than half had spirometry evidence of obstructive lung disease. The rates of inhaler prescriptions did not significantly differ amongst those patients with evidence of obstruction. This suggests that this cohort is over treated. Further evaluation of this cohort with objective measurements of their functional status and symptom burden is needed.
Author Block: M. Tole1, I. Rubinstein2; 1Pulmonary, Chicago, IL, United States, 2Univ of Illinois At Chicago, Chicago, IL, United States.
Rationale: There are many unmet needs for the advanced elderly in healthcare today. In our prior effort we described the disease pattern in COPD patients diagnosed by GOLD criteria. We now seek to expand this population to all physician diagnosed COPD patients in inner city Chicago and better describe the inhaler prescription pattern.
Methods: Medical records were reviewed of nonagenarians with physician diagnosed COPD at Jesse Brown VA Medical Center in Chicago, IL. When PFTs were available they were used to confirm the diagnosis of COPD based on GOLD criteria and to describe COPD severity based on FEV1. Smoking history, prescribed COPD medication and hospitalizations for COPD exacerbations in the preceding two years were recorded. Additionally the presence of Asthma, obstructive sleep apnea, coronary artery disease, congestive heart failure, diabetes and neoplasms was assessed.
Results: A total of 150 patients (147 male and 3 female) older than 90 years of age were included. A substantial smoking history was confirmed on 106 (70%) of the cohort. Pulmonary function testing was available for 88 (59%). And of those patients 64 (43%) had evidence of obstructive lung disease based on GOLD criteria of FEV1/FVC ratio of 70%. Short acting beta agonists were prescribed for 124 patients (86%). Muscarinic agents were available to 83 patients (56%). Long acting beta agonists (n:73) and inhaled corticosteroids (n:76) were available to nearly half the patients. Supplemental oxygen was prescribed in 34 patients (23%). Extensive tobacco use was documented in 106 patients (71%) of this cohort. Obstructive sleep apnea is noted in 17 patients (11%) and Congestive heart failure was seen in 48 patients (32%). Coronary artery disease was the most common comorbidity, seen in 73 patients (49%). Inhaler prescription rates did not differ in the patients with PFT evidence of obstructive lung disease.
Conclusion: Amongst the patients that carry a diagnosis of COPD less than half had spirometry evidence of obstructive lung disease. The rates of inhaler prescriptions did not significantly differ amongst those patients with evidence of obstruction. This suggests that this cohort is over treated. Further evaluation of this cohort with objective measurements of their functional status and symptom burden is needed.
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