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Concomitant asthma, COPD versus either disease alone linked with higher burden, data reveal

Saturday, August 16 2008 | Comments

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What's This? Patients with both asthma and chronic obstructive pulmonary disorder use more medical care and incur higher costs as compared with patients who have only one of the diseases, according to a retrospective cohort analysis published in the July issue of the journal Chest.

Using the Maryland Medicaid database, researchers assessed inpatient, outpatient and pharmacy claims from Jan. 1, 2001, through Dec. 31, 2003, from 9,131 patients aged 40 to 64 years. The patients were grouped by diagnosis--asthma only (n=3,072), COPD only (n=3,455) or asthma plus COPD (n=2,604).

Overall, co-occuring asthma and COPD were related to higher utilization of any service type as compared with either disease alone.

Multivariate logistic regression analysis showed that the odds of having physician and inpatient visits were more than five times higher for the patients with both asthma and COPD versus those with only asthma. The odds of having outpatient visits were approximately 2.4 times higher.

The adjusted analysis also revealed differences between the COPD only and asthma only cohorts. The odds of visiting a physician or receiving inpatient services were 16 percent and 51 percent higher, respectively, for the COPD only group as compared with the asthma only group. The odds of receiving outpatient services, however, were 60 percent lower for the COPD only group.

The concomitant disease group also had more than five times the costs as the asthma only group had. Estimates showed that medical costs averaged $2,307 for asthma, $4,879 for COPD and $14,914 for co-occuring disease.

Lead researcher Fadia Shaya told VerusMed that the study reminds providers about the importance of accurate coding of diagnoses.

"In the etiology and spectrum of COPD, the time spent by a given patient between the diagnoses of asthma and COPD presents real costs, as well as opportunity costs, i.e., the deferment of treatments specific to COPD," she explained. "Yet, these patients overutilize the medical system, are sicker and cost more, certainly than those with asthma, but also more than those with an established COPD diagnosis."

She suggested that primary care or specialist physicians should administer more aggressive COPD detection lung function tests. She said earlier intervention "could potentially effect significant improvements in COPD prognosis" and decrease the number of patients with both diagnoses.

In an accompanying editorial, Dr. David Mannino agreed that more attention is needed in this area.

"What is really needed is the development of a clear case definition for co-existing asthma and COPD in a cohort (either prospective or historical) that can then look at utilizations and other outcomes," Mannino wrote. "Future guidelines, both for asthma and COPD, need to better define and deal with the overlap between these disease entities."

Shaya told VerusMed that her study team is seeking to identify patterns among the Medicaid population that predict greater use of the services, as the study has significant implications for state Medicaid programs. Once patterns are found, they can provide recommendations for more specific disease management.

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