OBJECTIVES: The study examined medication use in elderly COPD patients before and after their hospitalization for COPD, and determined predictors for long-acting bronchodilator (LABD) use after hospitalization.

METHODS: This was a retrospective cohort study, conducted using data from a Medicare Advantage Plan (MAP). Patients with hospitalization for COPD between Jan 1, 2012 - Mar 31, 2014, continuously enrolled in the MAP for at least 12 months before and 9 months after first COPD hospitalization, at least 65 years old at index COPD hospitalization date, and without any cancer/end stage renal disease were included. Utilization of COPD medications within 90-day window before and after hospitalization for COPD, including LABD, short-acting bronchodilators (SABD), corticosteroids (CS), leukotriene modifiers, and phosphodiesterase-4 (PDE-4) inhibitors were examined. Stepwise logistic regression was conducted to determine the predictors for LABD fills after COPD hospitalization.

RESULTS: A total of 696 patients met the inclusion criteria, mean age 78 (±6.09, range 65-96) and 54.3% (n=378) women. Within 90-day pre-index hospitalization window, only 8.6% (n=60) of patients were prescribed any COPD medications, with 5.0% (n=35) on LABD, 3.6% (n=25) on SABA, and 3.5% (n=24) on CS. After hospitalization, COPD medication prescription increased to 11.4% (n=79), with fills for LABD prescription increased to 5.2% (n=36), SABA to 5.5% (n=38) and CS to 6.0% (n=42). Patients using CS (β=0.719, p<.05) or LABD (β=1.798, p<0.0001) within 90 days before hospitalization, and comorbid congestive heart failure (β=0.754, p<.05) were more likely to fill LABD prescription after index hospitalization.

CONCLUSIONS: The utilization of COPD medication in elderly MAP patients in our study was rather low. Despite the recommendation of using LABD to manage COPD, especially for those with exacerbations and COPD hospitalization, more than 90% of patients did not fill a LABD prescriptions. Interventions to improve post hospital use of LABA may help these patients.