CHEST Pulmonary (Sep 2024)

Short-Acting Beta-Agonists, Antibiotics, Oral Corticosteroids, and the Associated Burden of COPDTake-home Points

  • Mohit Bhutani, MD,
  • Arsh Randhawa, PhD,
  • Manisha Talukdar, PhD,
  • Phongsack Manivong, PhD,
  • Danielle Fearon, MSc, MPH,
  • Aaron Gelfand, MSc,
  • Erin Graves, MSc,
  • Suzanne McMullen, MHA,
  • Irvin Mayers, MD

Journal volume & issue
Vol. 2, no. 3
p. 100042

Abstract

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Background: Severe acute exacerbations of COPD (AECOPDs) are key events that drive health care resource use (HCRU) and negatively impact patients’ quality of life. Research Question: What is the real-world burden of COPD relative to patients’ medication history, specifically, exposure to short-acting beta-agonists (SABAs), antibiotics, and oral corticosteroids (OCSs)? Study Design and Methods: A population-based retrospective cohort study was conducted of patients in Alberta, Canada, identified as having COPD based on administrative health care data (April 1, 2011-March 31, 2019). The risk of severe AECOPDs over 90 days (COPD events resulting in hospitalization or ED visits) and COPD-specific HCRU were studied relative to prior-year SABA, antibiotic, and OCS history. Results: One hundred eighty-eight thousand nine hundred sixty-nine patients identified with COPD were identified (mean ± SD age, 68.8 ± 13.0 years). After controlling for age, sex, calendar year at index, comorbidities at index, and prior severe AECOPDs, patients with frequent SABA, antibiotic, or OCS exposure in a given year showed significantly higher 90-day risks of severe AECOPDs in a positively associated relationship. Patients with the highest SABA exposure (≥ 6 canisters in a given year) showed twice the rate of severe AECOPDs as patients with 1 SABA canister (incidence rate ratio [IRR], 2.06; 95% CI, 2.01-2.11). The 90-day rates of severe AECOPDs were 51% higher for patients with ≥ 6 vs 1 to 2 antibiotic dispensations (IRR, 1.51; 95% CI, 1.48-1.55) and 3% higher for patients with ≥ 6 vs 1 to 5 OCS burst days (IRR, 1.03; 95% CI, 1.00-1.06). Mean annualized rates of hospitalization and ED visits were highest for patients dispensed ≥ 6 (vs fewer) SABA canisters or antibiotics and patients with any OCS burst days in a given year. Interpretation: Histories of frequent or prolonged exposure to SABAs, antibiotics, or OCSs were associated with higher rates of severe AECOPDs and HCRU.

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