Analysis of inhaled corticosteroid and oral theophylline use among patients with stable COPD from 1987 to 1995

Study objective: To document temporal usage trends for commonly used respir atory medications in patients with COPD. Design: We retrospectively evaluated baseline concomitant medications of 3, 720 patients with COPD enrolled in 10 bronchodilator clinical trials from 1 987 to 1995, The proportion of patients in each trial using inhaled cortico steroids, inhaled beta-adrenergics, inhaled anticholinergics, oral theophyl line, and oral corticosteroids was analyzed using the Cochran-Armitage tren d test. Patients: All patients had stable, moderate-to-severe COPD without evidence of asthma or atopy, Reversibility to beta-agonists was not a requirement. Results: The percentage of patients using inhaled corticosteroids increased significantly over time (p < 0.001) from 13.2% in 1987 to 41.4% in 1995. T he percentage of patients receiving oral theophylline decreased significant ly (p < 0.001) over this same time interval (63.4 to 29.0%), In addition, t he percentage of patients using oral corticosteroids and the percentage usi ng oral beta-adrenergics decreased moderately (p < 0.05) (30.1 to 16.4% and 11.7 to 4.5%, respectively); the percentage of patients using inhaled anti cholinergics increased slowly (p < 0.05) (48.2 to 53.8%). The percentage of patients receiving inhaled beta-adrenergics did not significantly (p > 0.0 5) change. Conclusions: The observed changes in use of inhaled corticosteroids and the ophylline were not likely related to differences in disease severity or oth er patient characteristics in the evaluated trials, but related to changing prescribing and COPD management practices.