A39-09 Antitussive Prescribing Practices in Patients With Idiopathic Pulmonary Fibrosis

Purpose Cough significantly impacts quality of life and disease burden in patients with idiopathic pulmonary fibrosis (IPF). This study aims to describe common prescribing practices of antitussive medications in patients with IPF and investigate racial disparities using a large multi-center electronic health record database. Methods We utilized the TriNetX Research Network, a U.S.-based database of de-identified electronic health records from over 120 healthcare organizations. Patients with IPF were identified using ICD-10 codes, excluding those with sarcoid and chronic pain. Antitussive agents were identified using RxNorm codes. Propensity score matching was performed to balance cohorts by age and gender. The primary outcome was the prescription of oral antitussive medications. Statistical analyses included odds ratios (OR) with a significance threshold of p < 0.05. Results The study cohort included 46,749 patients with IPF (mean age: 77 years; 61.2% male). The racial distribution was predominantly White (74.5%), followed by Black (7.1%). For all patients, guaifenesin was the most prescribed non-opioid antitussive (23%), followed by benzonatate (19%), gabapentin (15%), and dextromethorphan (9%). Morphine (24%) was prescribed more frequently than hydrocodone (17%) and codeine (11%). After propensity score matching, Black patients were more likely to be prescribed benzonatate (OR: 1.203, CI 1.051-1.377), guaifenesin (OR: 1.228, CI 1.081-1.395), and dextromethorphan (OR: 1.423, CI 1.203-1.684) compared to White patients. There was no statistically significant difference in prescription of morphine (OR: 0.944, CI 0.834-1.067), hydrocodone (OR: 0.884, CI 0.762-1.024), codeine (OR: 1.063, CI 0.901-1.255), and gabapentin (OR 0.924, CI 0.801 - 1.067) between Black and White patients. Discussion This study highlights significant racial disparities in the prescribing patterns of antitussive medications in patients with IPF. Black patients were more likely to receive non-opioid antitussives compared to White patients. These differences may reflect systemic biases or variations in clinical decision-making and warrant further investigation into their underlying causes. Clinical Implications Understanding racial disparities in cough management is critical to ensuring equitable care delivery. Addressing these discrepancies may improve treatment outcomes and reduce the disease burden among minority populations. Future research should explore strategies to mitigate potential biases in prescribing practices for cough therapies in patients with IPF.