Title
A Cross-Sectional Analysis of Bronchodilator Prescribing in COPD and Cardiovascular Comorbidity
Date of Award
2015
Degree Type
Thesis
Degree Name
Master of Science in Pharmaceutical Sciences
Specialization
Health Outcomes
Department
Pharmacy Practice
First Advisor
Cynthia Willey
Abstract
Background: Bronchodilators used to treat Chronic Obstructive Pulmonary disease have been associated with adverse cardiovascular events. Moreover, the high prevalence of cardiovascular diseases (CVD) in COPD (8-40%) requires an evaluation of treatment differences between comorbid groups in order to understand the appropriateness of drug prescribing.
Objective: To determine whether COPD patients with concurrent CVD are less likely to be prescribed bronchodilators compared to those without CVD.
Methods: A retrospective cross-sectional study was conducted using the 2010 National Ambulatory Medical Care Survey (NAMCS) to quantify the association between concurrent CVD morbidity and the probability of receiving a bronchodilator prescription. Visits included patients ≥40 years who had COPD diagnosis. Survey-weighted data were analyzed through descriptive analysis, univariate (unadjusted) and multivariate (adjusted) logistic regression models. Demographics, patient, physician and visit characteristics were assessed as covariates in the models.
Results: Out of 11,627,061 ambulatory visits recorded by patients ≥40 years with COPD diagnosis, majority was male (57%), non-Hispanic White (80%) and used at least one bronchodilator (55.5%). We found that a significantly lower proportion of the COPD-CVD group (32.3%) was treated with bronchodilators versus 57.6% for the non-comorbid group. The effect of CVD on bronchodilator prescribing was modified by gender, beta-blockers and asthma. CVD patients who were female, not prescribed beta-blockers and not having concomitant asthma were 94% less likely to be prescribed bronchodilators compared the non-CVD females with the same characteristics. On the other hand, males not prescribed beta-blockers and not having concomitant asthma had 68% lower probability when CVD coexisted with COPD. Female CVD patients prescribed beta-blockers and not living with asthma had only a 20% chance of being a bronchodilator user than those without CVD. Cardiovascular disease did not affect the utilization of bronchodilators in males taking beta-blockers who either had or did not have asthma.
Conclusion: Concurrent CVD diagnosis is a significant factor for reducing the probability of prescribing bronchodilators for COPD and our findings provide evidence of variations in bronchodilator prescribing for stratified groups of COPD-CVD patients. Most patients with COPD and CVD are less likely to be prescribed bronchodilators, with the exception of males who were also prescribed beta-blockers. Thus, this study highlights a specific patient subgroup for whom the guidelines are less likely to be observed.
Recommended Citation
Adesanoye, Damilola Tejumola, "A Cross-Sectional Analysis of Bronchodilator Prescribing in COPD and Cardiovascular Comorbidity" (2015). Open Access Master's Theses. Paper 637.
https://digitalcommons.uri.edu/theses/637