Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika® and Acapella® Devices

Abstract

Purpose: Managing and preventing disease exacerbations are key goals of COPD care. Oscillating positive expiratory pressure (OPEP) devices have been shown to improve clinical outcomes when added to COPD standard of care. This retrospective database study compared real-world resource use and disease exacerbation among patients with COPD or chronic bronchitis prescribed either of two commonly used OPEP devices.

Patients and methods: Patients using the Aerobika^® (Trudell Medical International, London, ON, Canada) or Acapella^® (Smiths Medical, Wampsville, New York, USA) OPEP device for COPD or chronic bronchitis were identified from hospital claims linked to medical and prescription claims between September 2013 and April 2018; the index date was the first hospital visit with an OPEP device. Severe disease exacerbation, defined as an inpatient visit with a COPD or chronic bronchitis diagnosis, and all-cause healthcare resource utilization over 30 days and 12 months post-discharge were compared in propensity score (PS)-matched Aerobika device and Acapella device users.

Results: In total, 619 Aerobika device and 1857 Acapella device users remained after PS matching. After discharge from the index visit, Aerobika device users were less likely to have ≥1 severe exacerbation within 30 days (12.0% vs 17.4%, p=0.01) and/or 12 months (39.6% vs 45.3%, p=0.01) and had fewer 12-month severe exacerbations (mean, 0.7 vs 0.9 per patient per year, p=0.01), with significantly longer time to first severe exacerbation than Acapella users (log-rank p=0.01). Aerobika device users were also less likely to have ≥1 all-cause inpatient visit within 30 days (13.9% vs 20.3%, p<0.001) and 12 months (44.9% vs 51.8%, p=0.003) than Acapella users.

Conclusion: Patients receiving the Aerobika OPEP device, compared to the Acapella device, had lower rates of subsequent severe disease exacerbation and all-cause inpatient admission. This suggests that Aerobika OPEP device may be a beneficial add-on to usual care and that OPEP devices may vary in clinical effectiveness.

Keywords: OPEP; database; exacerbations; re-hospitalization; sputum clearance.

Figure 1

Patient Attrition. Notes: COPD and chronic bronchitis diagnoses were identified using ICD-9 codes 491.XX and 496 and ICD-10 codes J41.X and J44.X, not including emphysema given that it is not characterized by sputum production. Pharmacy and provider stability was used as a proxy for continuous enrollment, which was defined as stability of reporting claims in every month for at least one pharmacy in LRx or provider in Dx as well as at least one LRx claim for any medication and one Dx claim in the baseline period and the 12-month period after the index date. There were no patients excluded for incomplete data. Abbreviations: CDM, Hospital Charge Detail Master database; Dx, medical claims database; LRx, prescription claims database; OPEP, oscillating positive expiratory pressure.

Figure 2

Initial care setting of the index medical visit (A) and inpatient admissions anytime during the index medical visit (B) in the matched cohorts. Notes: Percentages in bold and with an asterisk (*) indicate a p-value<0.05 for the comparison of index visit care settings between the Aerobika device and Acapella users. Inpatient admissions in (B) included patients with inpatient as the initial care setting and patients who were admitted to inpatient from the emergency or outpatient department. Abbreviation: ED, emergency department.

Figure 3

Treatments received during index inpatient visits in the matched cohorts. Notes: Percentages in bold and with an asterisk (*) indicate a p-value<0.05 for the comparison of inpatient treatments between the Aerobika device and Acapella users who had an index inpatient visit. Utilization of LABA/LAMA and ICS/LABA/LAMA were also evaluated but not reported due to occurrence in less than 1% of patients. Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; OCS, oral corticosteroid; SABA, short-acting beta agonist; SAMA, short-acting muscarinic antagonist.

Figure 4

Kaplan-Meier analysis of time from index visit discharge date to first post-discharge severe exacerbation in the matched cohorts.