Abstract
Introduction
We performed a real-life retrospective analysis to assess the impact of long-acting bronchodilator therapy and associated exposure to inhaled corticosteroids (ICS) on all-cause and cardiovascular mortality in patients with chronic obstructive pulmonary disease (COPD).
Methods
We used record linkage data from patients with a diagnosis of COPD in Tayside, Scotland, between 2001 and 2010. All-cause and cardiovascular mortality were assessed using Cox proportional hazard regression.
Results
A total of 4,133 patients were included, mean FEV1 of 59.5 %, mean age of 68.9 years and mean follow-up of 4.6 years. There were 623 who were exposed to long-acting bronchodilators only and 3,510 to long-acting bronchodilators plus ICS. 1,372 patients (33 %) died during the study period. Compared with controls taking only long-acting bronchodilators either alone or in combination, all-cause mortality was reduced in patients taking long-acting muscarinic antagonist (LAMA) + ICS as dual therapy: adjusted hazard ratio 0.62 (95 % CI 0.45–0.85), but not by long-acting beta-agonist (LABA) + ICS: adjusted hazard ratio 1.02 (95 % CI 0.80–1.31). Cardiovascular mortality was not reduced by dual therapy with either LABA or LAMA and concomitant ICS exposure. All-cause and cardiovascular mortality were both reduced in patients taking triple therapy with LABA + LAMA + ICS: adjusted hazard ratio 0.51 (95 % CI 0.41–0.64) and 0.56 (95 % CI 0.35–0.90), respectively.
Conclusion
In patients exposed to ICS, concomitant use of LAMA alone as dual therapy or in combination with LABA as triple therapy were associated with reductions in all-cause mortality, while concomitant use of LABA without LAMA conferred no reduction. Moreover, only triple therapy was found to confer benefits on cardiovascular mortality.
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Acknowledgments
This study was funded by Scottish Centre for Respiratory Research, University of Dundee departmental funds.
Conflict of interest
Following are the conflicts of interest/financial disclosures of the authors: Arvind Manoharan has received support from Teva to attend the 2013 European Respiratory Society Congress and Chiesi to attend the 2014 meeting. Philip Short has received support from GSK to attend the European Respiratory Society Congress 2013. William Anderson has received support Chiesi to attend the European Respiratory Society Congress 2013. Brian Lipworth is on the advisory board/has done consulting activity for Chiesi, Boehringer-Ingelheim, Teva & Cipla; he is on the speaker bureau for Teva and received support from Boehringer-Ingelheim to attend the British Thoracic Society/European Respiratory Society Congress 2013. The Scottish Centre for Respiratory Research, University of Dundee has received unrestricted grant support from Chiesi, Teva & Almirall.
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Manoharan, A., Short, P.M., Anderson, W.J. et al. Impact of Long-Acting Bronchodilators and Exposure to Inhaled Corticosteroids on Mortality in COPD: A Real-Life Retrospective Cohort Study. Lung 192, 649–652 (2014). https://doi.org/10.1007/s00408-014-9611-8
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DOI: https://doi.org/10.1007/s00408-014-9611-8