Background: We sought to examine health care resource utilization in the last 6 months of life among patients who died with chronic obstructive pulmonary disease (COPD) compared with those who died with lung cancer and to examine geographic variations in care. Methods: We performed a retrospective cohort study of patients diagnosed as having COPD or lung cancer, who were seen in 1 of 7 Veteran Affairs medical centers primary care clinics and who died during the study period. Our outcome of interest was health care resource utilization in the last 6 months of life. Results: In the last 6 months of life, patients with COPD were more likely to visit their primary care providers but had fewer hospital admissions compared with patients with lung cancer. Patients with COPD had twice the odds

In the United States, COPD is the leading cause of respiratory-related deaths and is the third overall leading cause of death. 1 COPD often causes a progressive decline in quality of life and places patients at risk for acute respiratory failure that can require intensive care. Currently, there is no consensus on when discussions about preferences for end-oflife care should take place with these patients. The American Thoracic Society/European Respiratory Society guidelines on COPD recommend these discussions occur for patients with advanced disease while they are clinically stable. 2 Studies show the majority of patients with COPD would like to discuss their preferences for end-of-life care with clinicians, yet less than one-third have done so. 3,4 Studies examining patients dying with COPD or lung cancer have shown that patients with COPD receive more resource-intensive care that is consistent with preservation of life, including greater number of ICU days, and less focus on palliation of symptoms than patients

Rationale and Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease (COPD). We examined whether the use of inhaled corticosteroids among patients with COPD was associated with a decreased risk of lung cancer. Keywords: chronic obstructive pulmonary disease; pharmacoepidemiology; lung cancer; adherence Lung cancer is the most common cause of cancer related death in the United States, and accounts for more deaths each year than breast, prostate, and colorectal cancer combined (1). Studies such as the Lung Health Study have demonstrated that the most common cause of death among subjects with chronic ob-