The overall results of our sensitivity analyses for all-cause mortality for COPD (top panel) were consistent with those of our primary analyses. S2 depicts the results of our sensitivity analyses by using different grace periods for the sub-cohorts of COPD and asthma for the exposure contrast of SABA versus SAMA and the risk of all-cause mortality.
Sensitivity analysesĪdditional file 1: Fig. β 2-agonist-based drugs and hospitalization for pneumoniaĪs indicated in Table 3, there were no statistically significant associations between the risk of pneumonia and β 2-agonist-based drugs among patients with asthma, COPD, and asthma-COPD overlap, respectively, after adjusting for potential confounders. However, no statistically significant associations were found among asthma or asthma-COPD overlap patients. Cells with fewer than five events are not permitted to be displayed in the table due to CPRD confidentiality policies.įull size table β 2-agonist-based drugs and the risk for all-cause mortalityĪfter controlling for potential confounders, current and new users of SABA (adjusted HR, 1.82 ) and LABA (adjusted HR, 2.77 ) were significantly associated with an increased risk of all-cause mortality among COPD patients. Table 3 shows the multivariate analyses of all-cause mortality and pneumonia after accounting for all baseline variables listed in Tables 1 and 2. However, the baseline characteristics of case patients with systolic blood pressure, deprivation (material deprivation), and NSAID prescription were fairly balanced across OADs. Cases were also more likely to be current smokers, the most deprived, have at least two or more comorbidities (Charlson Index), and prescribed more loop diuretics, aspirin, opioids, and insulin. Except for patients with COPD, case patients were more likely to be obese regarding all-cause mortality. On the other hand, Pneumonia patients were more likely to be females with asthma, whereas COPD and asthma-COPD overlap patients were more likely to be males. 1.Īmong cases with all-cause mortality, controls were less likely to be females than males. The schematic design of the nested case–control analysis employed is shown in Fig. The case’s index date became the index date for those matched controls selected randomly at the risk-set. For each case, we randomly selected up to 10 controls within the cohort on the basis of sex, age (± 1 year), date of cohort entry (± 180 days), and duration of follow-up. The study cohort included all males and females diagnosed with asthma, COPD, or asthma-COPD overlap in the CPRD aged 18 or over with a first-ever prescription for a LABA, SABA, combination therapy of ICS/LABA, ICS, LAMA or SAMA.Ī risk-set sampling method was used to match the case with a random sample from the risk set for each case occurring during the study follow-up.
The study protocol was approved by the Independent Scientific Advisory Committee of the CPRD (ISAC 18_005RA) and ethical approval was obtained from Health Research Ethics Board at Memorial University, St. This study was conducted using the United Kingdom Clinical Practice Research Datalink (CPRD) linked to the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases, representing the UK’s geographical distribution. Given the steadily growing trend of β2-agonists-based drug prescriptions (58–185%) in patients with asthma and, more specifically, COPD, there is a need to investigate whether these widely prescribed drugs are associated with an increased risk of all-cause mortality and hospitalization for pneumonia. Nevertheless, information on the risk of all-cause mortality and pneumonia is limited, and the results are inconsistent. Β2-agonists provide necessary bronchodilatory action and are recommended by existing clinical practice guidelines, and are widely prescribed for patients with these conditions. Furthermore, an increasing number of people are affected by asthma-COPD overlap, with 15 to 45% of older adults initially diagnosed with COPD or asthma. Likewise, chronic obstructive pulmonary disease (COPD) was ranked as the 4th leading cause of death in 2019 and caused considerable morbidity and substantial health care costs. Asthma is a significant public health problem worldwide, causing excess morbidity, mortality, and economic costs.
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