171 Antibiotic Prescribing Patterns and Associated Factors in Patients with Asthma and COPD: An Analysis of NHANES Data (2007–2018)

Introduction/Objective Antibiotic resistance is a persistent global health threat, exacerbated by inappropriate prescribing. Asthma and chronic obstructive pulmonary disease (COPD) are major respiratory conditions often treated with antibiotics, even when viral exacerbations dominate. Understanding prescribing patterns in these populations is critical for optimizing clinical decision-making and promoting antibiotic stewardship. This study aimed to evaluate national trends and predictors of antibiotic use among U.S. adults with asthma and/or COPD using data from the National Health and Nutrition Examination Survey (NHANES) from 2007-2018. Methods/Case Report A cross-sectional analysis was conducted using NHANES data from adults aged 20 years and older. Participants were categorized into four groups: general population (no respiratory disease), asthma only, COPD only, and both asthma and COPD. The primary outcome was the use of prescription antibiotics within the prior 30 days. Key covariates included age, sex, race/ethnicity, education, insurance status, Body Mass Index (BMI), and self-reported health status. Survey-weighted logistic regression models were used to examine associations between respiratory condition and antibiotic use: Model 1 (unadjusted), Model 2 (adjusted for sociodemographics), and Model 3 (fully adjusted for health-related factors). Temporal trends were also assessed across three time periods: 2007–2012, 2013–2014, and 2015–2018. Results Antibiotic use was significantly higher among individuals with asthma and/or COPD compared to those without (crude OR = 1.43, 95% CI: 1.16–1.76). After full adjustment, the association was attenuated and became statistically nonsignificant. The highest prevalence of use was observed in individuals with both asthma and COPD (5.5%), versus 3.1% among those without respiratory conditions. Overall, antibiotic use rose modestly over the 12 years, with subgroup trends showing slight declines among older adults, individuals with obesity, and those with lower educational attainment. The most frequently prescribed antibiotic classes were penicillins, macrolides, and quinolones. Long-term use remained stable at approximately 1%. Conclusion Antibiotic prescribing is more prevalent among individuals with asthma and COPD compared to those without respiratory conditions. However, this association diminishes after adjusting for key sociodemographic and health-related factors, suggesting that comorbidities, access to care, and broader health determinants play a significant role in driving prescription trends. These findings emphasize the importance of context-specific clinical judgment and the need for more nuanced prescribing practices that distinguish between bacterial and non-bacterial exacerbations in chronic respiratory diseases. By identifying which patient groups are more likely to receive antibiotics unnecessarily, we can tailor interventions and guidelines to reduce inappropriate use. Ultimately, incorporating data-driven insights from national surveillance sources like NHANES can support targeted stewardship efforts, improve care quality, and slow the progression of antibiotic resistance on a population level.