Greater Access to Long Acting Beta2 Agonists Is Associated with Less Hospital Admissions Due to COPD: A Longitudinal Nation-Wide Study

Abstract

Purpose: Long Acting Beta₂ Agonists (LABA) prevent COPD exacerbations in strictly standardized clinical trials. Our aim was to evaluate the relationship between the amount of LABA provided by the government and the trend in COPD hospital admission (HA) rate in Brazil.

Methods: This is a longitudinal large-scale real-life study. We calculated COPD HA rate and the number of subjects per 10⁵ inhabitant who received LABA supplied by the government in each Brazilian municipality, between years 2004 and 2013. We used Poisson Multilevel Regression analysis to calculate the rate ratio between LABA dispensation rate and COPD HA rate.

Results: In Brazil, COPD HA rate reduced 59% among subjects between 40 and 59 years of age and 60% among subjects older than 59 years of age. Most of the 5506 Brazilian municipalities reduced COPD HA rate [4149 (75%) municipalities & 1357 (25%) municipalities]. The dispensation of LABA was greater among municipalities that reduced COPD HA rate. In the 40-59 age group, the gap in LABA dispensation between the two groups of municipalities increased during the study period from 90.40 to 614.28 subjects per 10⁵ inhabitants. In the > 59 age group, the gap in LABA dispensation increased from 35.87 to 912.99 subjects per 10⁵ inhabitants. For each one hundred subjects who received LABA there was less one HA (RR 0.99, 95 CI 0.99-0.99).

Conclusions: COPD HA rate reduced in Brazil. LABA dispensation growth was associated with COPD HA rate reduction.

Keywords: COPD; Epidemiology; Hospitalization; Public health; Treatment.