Comparison of inhaled long-acting β-agonist and anticholinergic effectiveness in older patients with chronic obstructive pulmonary disease: a cohort study.

Abstract

BACKGROUND:

Chronic obstructive pulmonary disease (COPD), a largely preventable and manageable respiratory condition, affects an estimated 12% to 20% of adults. Long-acting inhaled β-agonists and anticholinergics have both been shown to improve COPD outcomes and are recommended for moderate to severe disease; however, little is known about their comparative effectiveness.

OBJECTIVE:

To compare survival in older patients with COPD who initially receive inhaled long-acting β-agonists with that of patients who receive anticholinergics.

DESIGN:

Population-based, retrospective cohort study.

SETTING:

Ontario, Canada.

PATIENTS:

Patients aged 66 years or older (who carry the largest burden of COPD and for whom data were available) who met a validated case definition of COPD on the basis of health administrative data and were newly prescribed an inhaled long-acting β-agonist or a long-acting anticholinergic (but not both) between 2003 and 2007. Patients were followed for up to 5.5 years.

MEASUREMENTS:

The primary outcome was all-cause mortality.

RESULTS:

A total of 46 403 patients with COPD (mean age, 77 years; 49% women) were included. Overall mortality was 38.2%. Mortality was higher in patients initially prescribed a long-acting anticholinergic than in those initially prescribed a long-acting inhaled β-agonist (adjusted hazard ratio, 1.14 [95% CI, 1.09 to 1.19]). Rates of hospitalizations and emergency department visits were also higher in those initially prescribed a long-acting anticholinergic.

LIMITATION:

Patients were classified as having COPD on the basis of health administrative records, which did not contain information about lung function.

CONCLUSION:

Older adults initially prescribed long-acting inhaled β-agonists for the management of moderate COPD seem to have lower mortality than those initially prescribed long-acting anticholinergics. Further research is needed to confirm these findings in younger patients and in a randomized, controlled trial.

PRIMARY FUNDING SOURCE:

Government of Ontario, Canada.

• Authors: Andrea Gershon, Ruth Croxford, Teresa To, Matthew B Stanbrook, Ross Upshur, Paula Sanchez-Romeu, Thérèse Stukel
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 154 Issue 9 Pg. 583-92 (May 03 2011) ISSN: 1539-3704 [Electronic] United States
• PMID: 21536937 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Agonists
• Bronchodilator Agents
• Cholinergic Antagonists

Topics

• Administration, Inhalation
• Adrenergic beta-Agonists (administration & dosage, therapeutic use)
• Aged
• Bronchodilator Agents (administration & dosage, therapeutic use)
• Cause of Death
• Cholinergic Antagonists (administration & dosage, therapeutic use)
• Female
• Humans
• Male
• Ontario (epidemiology)
• Propensity Score
• Proportional Hazards Models
• Pulmonary Disease, Chronic Obstructive (drug therapy, mortality)
• Retrospective Studies
• Sensitivity and Specificity
• Treatment Outcome