Elsevier

Clinical Therapeutics

Volume 22, Issue 4, April 2000, Pages 452-469
Clinical Therapeutics

Inhaled corticosteroid use and associated outcomes in elderly patients with moderate to severe chronic pulmonary disease

https://doi.org/10.1016/S0149-2918(00)89013-XGet rights and content

Abstract

Objective

This study was undertaken to examine the impact of select demographic, clinical, and medication-related factors on elderly patients' medication adherence to inhaled corticosteroid therapy. It also examined the impact of medication adherence on health outcomes and on health care service utilization and costs.

Background

Asthma in the elderly is a growing concern because of its increasing prevalence and the increase in asthma-related deaths. Poor medication utilization could be contributing to this trend in the elderly population and should be examined.

Methods

This retrospective, longitudinal, 2-year cohort study included 1595 patients aged ≥65 years with moderate to severe chronic pulmonary disease who were enrolled in a health maintenance organization. The study used sequential regression analyses to model (1) medication adherence and (2) health care service utilization and charges as functions of adherence.

Results

With other factors controlled for, this study found that clinical and medicationrelated variables including comorbidities, additional complications, and number of medications were predictive of adherence to prophylactic inhaled corticosteroid therapy in this population. Poorer medication adherence was associated with a 5% increase in total annual physician visits (P < 0.05). Better medication adherence was associated with a 20% decrease in annual hospitalization (P < 0.05). Additional pulmonary complications and severe comorbidities were associated with increases in health care utilization and costs. Patients with better adherence to prophylactic therapy were few, and the beneficial effects of better adherence were not significant when the population averages were considered.

Conclusions

The results of this study indicated that the beneficial effects of better adherence to prophylactic inhaled corticosteroid therapy tended to diminish in a population with relatively poor medication adherence. Findings of this study support a policy of selectively targeting elderly patients at risk for morbidity and implementing monitoring, education, and management programs to increase medication-adherence behavior. This policy could lead to optimal resource utilization and management of chronic pulmonary disease.

References (31)

  • BurrML et al.

    Asthma in the elderly: An epidemiological survey

    Br Med J.

    (1979)
  • HorslyJR et al.

    Respiratory symptoms among elderly people in the New Forest area assessed by a postal questionnaire

    Age Ageing.

    (1991)
  • LucePJ

    Asthma in the elderly

    Br J Hosp Med.

    (1996)
  • HaynesRB

    Introduction

  • SmithDH et al.

    A national estimate of economic costs of asthma

    Am J Respir Crit Care Med.

    (1997)
  • Cited by (49)

    • The Impact of Inhaler Device Regimen in Patients with Asthma or COPD

      2021, Journal of Allergy and Clinical Immunology: In Practice
      Citation Excerpt :

      Poor adherence leads to negative clinical consequences, which may have an economic impact, as shown in a retrospective study of patients aged 65 years and older with moderate-to-severe asthma, COPD, chronic bronchitis, chronic airway obstruction, or emphysema, who were treated with inhaled corticosteroids. Poorer medication adherence was associated with a significant increase in total annual physician visits, and better adherence was associated with a significant decrease in the number of annual hospitalizations.38 Studies suggest that inhaler device and preference can influence adherence, persistence, or both.23,24,35,36,39

    • Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study

      2018, Research in Social and Administrative Pharmacy
      Citation Excerpt :

      Non-adherence with their treatment recommendations can be both intentional (such as, negative attitudes to medication-taking behavior, side effects, cost, does not feel sick, etc.) and unintentional, due to reasons related to forgetting, misunderstanding, problems in remembering, failure to plan ahead, etc.16 In addition, there are concerns with inhaler technique, which is typically seen as sub-optimal2,17 with adherence adversely affected if patients are using different devices requiring different techniques.18 However, it is evident that better medication adherence is associated with a decrease in the number of emergency department visits and length of hospital stay among patients with chronic respiratory diseases19 with improved adherence reducing costs.20 Consequently, in order for a medication to be useful, not only should the active ingredient be effective, and its delivery must be optimal, but also patients' adherence to their medications is an essential factor for success of therapy.6

    • Cost-Utility Analysis of Long-Acting Beta Agonists versus Leukotriene Receptor Antagonists in Older Adults with Persistent Asthma Receiving Concomitant Inhaled Corticosteroid Therapy

      2016, Value in Health
      Citation Excerpt :

      We did not calculate asthma hospitalization rate for ICS-only patients using Medicare data to avoid the potential confounding by asthma severity because those treated by ICS monotherapy usually have less severe asthma. Instead, we used historical data [49] to extract asthma event rates in patients treated with ICS alone before the widespread use of the add-on treatments. Although there might be some discrepancy between the Medicare cohort and the historical cohort, the focus of this study was to compare the two add-on treatments, which should not be affected by this possible discrepancy.

    • Safety and efficacy of the once-daily anticholinergic BEA2180 compared with tiotropium in patients with COPD

      2013, Respiratory Medicine
      Citation Excerpt :

      None of the events leading to death were considered to be related to study medication and the causes of death were consistent with those expected in a patient population of >10 pack-year smokers. Therapeutic delivery is a key concern of COPD maintenance treatment, given issues of device use and compliance.2,19 In many countries, tiotropium is administered via the Respimat® SMI, a novel propellant-free inhaler with a soft-mist aerosol delivering fine-particle fraction.

    View all citing articles on Scopus
    View full text