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Incidence, Predictors, and Clinical Implications of Discontinuing Therapy with Inhaled Long-Acting Bronchodilators among Patients with Chronic Obstructive Pulmonary Disease
- Source :
- COPD. 13(5)
- Publication Year :
- 2016
-
Abstract
- Incidence, predictors and effect of discontinuation of long-acting bronchodilators on the risk of death or hospital admission among adults with Chronic Obstructive Pulmonary Disease (COPD) were assessed in a large population-based prospective study carried out by linking Italian healthcare utilization databases. Specifically, the cohort of 17,490 beneficiaries of the National Health Service in the Italian Region of Lombardy, aged 40 years or older, who started long-acting bronchodilators therapy during 2005–2008 was followed from first dispensation until 2012. During this period, patients who experienced discontinuation of long-acting bronchodilators were identified. Hospitalizations for COPD and deaths for any cause (composite clinical outcome) were also identified during follow-up. A Cox proportional hazards model was fitted to identify predictors of discontinuation. The case-crossover design was used to assess the implications of treatment discontinuation on the clinical outcome risk. Cumulative incidences of discontinuation were, respectively, 67%, 80%, and 92% at 6 months, 1 year, and 5 years since initial treatment. Significant predictors of discontinuation were female gender, younger age, starting treatment with fixed-dose combination of inhaled bronchodilators and corticosteroids, using antibiotics, inhaled long-acting bronchodilators and corticosteroids and not using short-acting bronchodilators, other respiratory drugs and systemic corticosteroids during follow-up. Odds ratios (95% confidence intervals) for the clinical outcome associated with not discontinuing long-acting bronchodilators was 0.64 (0.50 to 0.82). In conclusion, in the real-life setting, discontinuation of inhaled long-acting bronchodilators in adults with COPD is high even after just 6 months, even though persistence to these drugs reduces the risk of severe outcomes.
- Subjects :
- Male
Pulmonary Disease, Chronic Obstructive
0302 clinical medicine
Adrenal Cortex Hormones
Risk Factors
Medicine
030212 general & internal medicine
Prospective Studies
Prospective cohort study
Aged, 80 and over
COPD
Chronic obstructive pulmonary disease
Incidence (epidemiology)
Age Factors
persistence
Middle Aged
Anti-Bacterial Agents
Bronchodilator Agents
Hospitalization
Drug Combinations
Italy
Cohort
Female
Medical Record Linkage
healthcare utilization database
Pulmonary and Respiratory Medicine
Adult
medicine.medical_specialty
long-acting bronchodilators
03 medical and health sciences
Sex Factors
death
Internal medicine
Humans
Mortality
Intensive care medicine
Aged
business.industry
Proportional hazards model
Odds ratio
medicine.disease
Confidence interval
Discontinuation
hospital admission
030228 respiratory system
Withholding Treatment
Delayed-Action Preparations
long-acting bronchodilator
discontinuation
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 15412563
- Volume :
- 13
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- COPD
- Accession number :
- edsair.doi.dedup.....5fc919220f0232fb728d5790d9cec4ff