Researchers Assess Impact of Comorbidities, Commonly Used Drugs on Mortality in COPD

February 3, 2020

Among patients with chronic obstructive pulmonary disease (COPD), heart failure, stroke, and myocardial infarction were highly associated with an increased risk of death. Mortality risk was more strongly associated with the use of long-acting muscarinic antagonists and N-acetylcysteine compared with the lesser risk from inhaled corticosteroids, beta-blockers, and acetylsalicylic acid, according to study findings.

Among patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), stroke, and myocardial infarction (MI) were highly associated with an increased risk of death. Mortality risk was more strongly associated with the use of long-acting muscarinic antagonists and N-acetylcysteine compared with the lesser risk from inhaled corticosteroids, beta-blockers, and acetylsalicylic acid, according to study findings published in the International Journal of Chronic Obstructive Pulmonary Disease.

COPD is an incurable lung disease that affects 27 million in the United States. It contributes to an estimated 2.9 million deaths each year. Although there is no cure for one of the world’s major causes of mortality worldwide, COPD is treatable, with optimal therapies linked with slowing the disease, treating symptoms, and preventing exacerbations. In many of these affected patients, the presence of multiple comorbidities can impact the effectiveness of care, indicating the need to assess the efficacy of these medications on mortality risk.

Researchers sought to uncover associations between commonly used drugs, comorbidities, and mortality by examining patients with COPD, retrospectively and observationally, from a real-world primary care cohort in Sweden who have an 8.3-year shorter overall life expectancy than that of the general population. The study cohort (n = 17,745) included patients from 76 primary healthcare centers whose HF was diagnosed between January 1, 1999, and December 31, 2009. The main outcome of interest was as all-cause mortality.

All-cause death was assessed in a stepwise multiple Cox proportional hazards regression model that included demographics, socioeconomic factors, exacerbations, comorbidities, and medication. During the observation period, 5776 (32.5%) of the study participants with COPD died.

When examining what comorbidities were most associated with mortality, the researchers found that HF (HR, 1.88; 95% CI, 1.74-2.04), stroke (HR, 1.52; 95% CI, 1.40-1.64), and MI (HR, 1.40; 95% CI, 1.24-1.58) were the strongest predictors of death.

For associations relating to treatment usage and mortality risk, inhaled corticosteroids (HR, 0.79; 95% CI, 0.66-0.94), beta-blockers (HR, 0.86; 95% CI, 0.76-0.97), and acetylsalicylic acid (HR, 0.87; 95% CI, 0.77-0.98) were all dose-dependently linked with a decreased risk of death. Conversely, long-acting muscarinic antagonists (LAMAs) (HR, 1.33; 95% CI, 1.14-1.55) and N-acetylcysteine (HR, 1.26; 95% CI, 1.08-1.48) were dose-dependently associated with an increased risk of death in patients with COPD.

Increasing evidence shows the effectiveness of a combination medication of a LAMA and a long-acting beta antagonist (LABA) on patients with COPD, warranting further research into the mortality risk posed by LAMAs and whether they are offset by LABAs.

The researchers highlighted the need to further examine the safety and efficacy of medications linked with decreased mortality risk, and they stressed the need to assess the comorbidities found to be strongly linked to death.

“Timely recognition and appropriate treatment of these and other comorbidities may improve prognosis, underscoring the importance of a multidimensional and thorough assessment of COPD patients in primary as well as secondary care,” said the study authors.

Reference

Ellingsen J, Johansson G, Larsson K, et al. Impact of comorbidities and commonly used drugs on mortality in COPD — real-world data from a primary care setting [published online February 3, 2020]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S231296.