Prescription Status and Clinical Outcomes of Methylxanthines and Leukotriene Receptor Antagonists in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Int J Chron Obstruct Pulmon Dis. 2019 Nov 27;14:2639-2647. doi: 10.2147/COPD.S216326. eCollection 2019.


Background: Methylxanthines and leukotriene receptor antagonists (LTRA) are not a first-line medical treatment for chronic obstructive pulmonary disease (COPD) but are frequently prescribed despite limited evidence. We aimed to elucidate the real prescribing status and clinical impacts of these agents in early COPD patients.

Methods: Patients with mild-to-moderate COPD (FEV1>50%) were selected from the Korean National Health and Nutrition Examination Survey data between 2007 and 2012. Besides analyzing the prescription status of methylxanthines and LTRA and the contributing factors to the prescription, we evaluated the clinical impacts of these drugs on the exacerbation, hospitalization, and medical costs.

Results: Of 2269 patients with mild-to-moderate COPD, 378 patients (16.7%) were under medical treatments, and the users of methylxanthines and/or LTRA were 279 patients (12.3%); however, only 139 patients (6.1%) were inhaler users. The contributing factors for the prescription of methylxanthines were a comorbidity of asthma or allergic disease, poor lung function, low quality of life, prescribing doctor from the specialty of internal medicine, and an institution type of private hospital. The prescription of LTRA was associated with the comorbidity of allergic disease. The methylxanthine and/or LTRA users had more hospital utilization but did not have significant differences in acute exacerbations and medical cost for hospital utilization, compared with the non-users.

Conclusion: Methylxanthines and LTRA were used in a significant proportion of patients with mild-to-moderate COPD in real fields without favorable impacts on the exacerbations, hospitalizations, or medical costs. The use of more effective inhaled medications should be encouraged.

Keywords: chronic obstructive; drug prescriptions; leukotriene antagonists; methylxanthine; pulmonary disease.

MeSH terms

  • Aged
  • Bronchodilator Agents / adverse effects
  • Bronchodilator Agents / economics
  • Bronchodilator Agents / therapeutic use*
  • Disease Progression
  • Drug Costs
  • Drug Prescriptions
  • Drug Utilization / trends
  • Female
  • Forced Expiratory Volume
  • Hospital Costs
  • Hospitalization
  • Humans
  • Leukotriene Antagonists / adverse effects
  • Leukotriene Antagonists / economics
  • Leukotriene Antagonists / therapeutic use*
  • Lung / drug effects*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Practice Patterns, Physicians' / trends*
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / economics
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Republic of Korea
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Xanthines / adverse effects
  • Xanthines / economics
  • Xanthines / therapeutic use*


  • Bronchodilator Agents
  • Leukotriene Antagonists
  • Xanthines
  • methylxanthine