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

Objective: This study was undertaken to examine the impact of select demogr aphic, clinical, and medication-related factors on elderly patients' medica tion adherence to inhaled corticosteroid therapy. It also examined the impa ct of medication adherence on health outcomes and on health care service ut ilization and costs. Background: Asthma in the elderly is a growing concern because of its incre asing 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 159 5 patients aged greater than or equal to 65 years with moderate to severe c hronic pulmonary disease who were enrolled in a health maintenance organiza tion. 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 medication-related variables including comorbidities, additional compli cations, and number of medications were predictive of adherence to prophyla ctic inhaled corticosteroid therapy in this population. Poorer medication a dherence 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 a nd severe comorbidities were associated with increases in health care utili zation and costs. Patients with better adherence to prophylactic therapy we re 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 effect s of better adherence to prophylactic inhaled corticosteroid therapy tended to diminish in a population with relatively poor medication adherence. Fin dings of this study support a policy of selectively targeting elderly patie nts at risk for morbidity and implementing monitoring, education, and manag ement programs to increase medication-adherence behavior. This policy could lead to optimal resource utilization and management of chronic pulmonary d isease.