A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika OPEP

Pulmonary Therapy, Feb 2017

Introduction Oscillating positive expiratory pressure (OPEP) devices may reduce chronic symptoms in patients with obstructive pulmonary disease (COPD); however, no real-world studies have been performed to evaluate the benefits of these devices. The objective of this study was to measure the rate of early (30-day) moderate-to-severe exacerbations and related costs in COPD patients treated with Aerobika, an OPEP device, vs. a matched control group in a real-world setting. Methods The study utilized data from the QuintilesIMS’ CDM hospital database. COPD patients treated with Aerobika OPEP between 9/2013 and 8/2015 were propensity score matched to COPD patients who did not use any positive expiratory pressure device. Severe exacerbation was defined as a hospital admission with a diagnosis for chronic bronchitis or COPD. Moderate-to-severe exacerbation was defined as a hospitalization or an ED visit with a diagnosis for chronic bronchitis or COPD. Exacerbations and costs were compared between cohorts at 30 days. A generalized linear model (GLM) was used to estimate the marginal effect of Aerobika OPEP on the cost of ED visits and hospitalizations due to COPD exacerbations. Results A total of 405 Aerobika OPEP patients were matched to 405 controls. At 30 days, 18.5% of subjects using the Aerobika OPEP vs. 25.7% of controls had a moderate-to-severe exacerbation (p = 0.014); 13.8% of subjects with Aerobika OPEP vs. 19.0% of controls had a severe exacerbation (p = 0.046). The mean per patient cost of moderate-to-severe exacerbations and severe exacerbations in the Aerobika OPEP group was significantly lower than controls ($2975 vs. $6065; p = 0.008, and $2838 vs. $5871; p = 0.009, respectively). In the GLM, the per-patient cost of moderate-to-severe exacerbations in the Aerobika OPEP group was 34% lower (p = 0.012) than the control group. Conclusions Study findings suggest that using Aerobika OPEP as part of a treatment regimen may help reduce ED visits, hospital re-admissions and related costs in COPD patients who have a history of exacerbations.

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A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika OPEP

Pulmonary Therapy June 2017, Volume 3, Issue 1, pp 163–171 | Cite as A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika OPEP AuthorsAuthors and affiliations Chakkarin BurudpakdeeArpamas SeetasithPatrick DunneGarry KauffmanBrian CarlinDom CoppoloJason Suggett Open Access Original Research First Online: 06 February 2017 15 Shares 2.3k Downloads 2 Citations Abstract Introduction Oscillating positive expiratory pressure (OPEP) devices may reduce chronic symptoms in patients with obstructive pulmonary disease (COPD); however, no real-world studies have been performed to evaluate the benefits of these devices. The objective of this study was to measure the rate of early (30-day) moderate-to-severe exacerbations and related costs in COPD patients treated with Aerobika, an OPEP device, vs. a matched control group in a real-world setting. Methods The study utilized data from the QuintilesIMS’ CDM hospital database. COPD patients treated with Aerobika OPEP between 9/2013 and 8/2015 were propensity score matched to COPD patients who did not use any positive expiratory pressure device. Severe exacerbation was defined as a hospital admission with a diagnosis for chronic bronchitis or COPD. Moderate-to-severe exacerbation was defined as a hospitalization or an ED visit with a diagnosis for chronic bronchitis or COPD. Exacerbations and costs were compared between cohorts at 30 days. A generalized linear model (GLM) was used to estimate the marginal effect of Aerobika OPEP on the cost of ED visits and hospitalizations due to COPD exacerbations. Results A total of 405 Aerobika OPEP patients were matched to 405 controls. At 30 days, 18.5% of subjects using the Aerobika OPEP vs. 25.7% of controls had a moderate-to-severe exacerbation (p = 0.014); 13.8% of subjects with Aerobika OPEP vs. 19.0% of controls had a severe exacerbation (p = 0.046). The mean per patient cost of moderate-to-severe exacerbations and severe exacerbations in the Aerobika OPEP group was significantly lower than controls ($2975 vs. $6065; p = 0.008, and $2838 vs. $5871; p = 0.009, respectively). In the GLM, the per-patient cost of moderate-to-severe exacerbations in the Aerobika OPEP group was 34% lower (p = 0.012) than the control group. Conclusions Study findings suggest that using Aerobika OPEP as part of a treatment regimen may help reduce ED visits, hospital re-admissions and related costs in COPD patients who have a history of exacerbations. KeywordsCOPD Exacerbations PEP OPEP  Enhanced content To view enhanced content for this article go to http://www.medengine.com/Redeem/E587F06068790517. Electronic supplementary material The online version of this article (doi: 10.1007/s41030-017-0027-5) contains supplementary material, which is available to authorized users. Introduction Chronic obstructive pulmonary disease (COPD) is a major source of morbidity, mortality, and costs. The biggest driver of these healthcare costs is hospitalization [1]. COPD affects approximately 5% of the US adult population and is often associated with exacerbations [2, 3, 4]. Acute exacerbations are the most frequent causes for medical visits, hospital admissions, early readmissions, and death in patients with COPD [5]. It is predicted that by 2030, COPD-related hospitalization will increase by 210% compared to 2010 levels [6]. Of note, one out of five patients hospitalized for a COPD exacerbation required re-hospitalization within 30 days [7]. During an exacerbation, airways are compromised by inflammation and mucus build up, which, in turn, increase lung hyperinflation [8]. Many COPD patients experience two to three exacerbations every year, suggesting a continued need to manage their disease [9, 10, 11]. According to GOLD guidelines, smoking cessation agents, pharmacologic therapy, and rehabilitation are currently recommended for the treatment of COPD [12]. Drug-free airway clearance methods such as oscillating positive expiratory pressure (OPEP) have been proposed to provide benefit in COPD patients though opening and vibrating airways and mobilizing bronchial secretions with increased sputum [13]. Aerobika (TMI, London, ON) is a hand-held mechanical OPEP device where patients exhale against a manually adjusted variable resistance. Aerobika has been shown to significantly improve forced vital capacity (FVC), 6-min walk distance (6MWD), and St. George’s Respiratory Questionnaire (SGRQ) score in COPD patients [14]. However, the effectiveness of an OPEP device, such as Aerobika, in reducing the COPD exacerbations has not been studied in a real-world setting. The purpose of this study was to measure the rate of moderate-to-severe early (30-day) COPD exacerbations and related costs. Methods This retrospective database study utilized patient data from January 1, 2011 to September 30, 2015 in the QuintilesIMS CDM hospital database. The database consists (...truncated)


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Chakkarin Burudpakdee, Arpamas Seetasith, Patrick Dunne, Garry Kauffman, Brian Carlin, Dom Coppolo, Jason Suggett. A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika OPEP, Pulmonary Therapy, 2017, pp. 163-171, Volume 3, Issue 1, DOI: 10.1007/s41030-017-0027-5