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.

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