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Cited by 121Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesInhalation and Respiratory Drug Delivery

Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease

Gershon, Andrea S., Campitelli, Michael A., Croxford, Ruth, Stanbrook, Matthew B., To, Teresa, Upshur, Ross, Stephenson, Anne L., Stukel, Thérèse A.·2014·JAMA
DOI 10.1001/jama.2014.11432
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Abstract

IMPORTANCE: Chronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes. OBJECTIVE: To estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting. DESIGN, SETTING, AND PATIENTS: Population-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA-inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively. EXPOSURES: Newly prescribed combination LABAs and inhaled corticosteroids or LABAs alone. MAIN OUTCOMES AND MEASURES: Composite outcome of death and COPD hospitalization. RESULTS: The main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, -3.7%; 95% CI, -5.7% to -1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, -6.5%; 95% CI, -10.3% to -2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, -8.4%; 95% CI, -11.9% to -4.9%; HR, 0.79; 95% CI, 0.73-0.86). CONCLUSIONS AND RELEVANCE: Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization.

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Authors
Gershon, A. S., Campitelli, M. A., Croxford, R., Stanbrook, M. B., To, T., Upshur, R., Stephenson, A. L., & Stukel, T. A.
Affiliations
  • Sunnybrook Health Science Centre (CA)
  • Institute for Clinical Evaluative Sciences (CA)
  • University Health Network (CA)
  • University of Toronto (CA)
  • St. Michael's Hospital (CA)
Corresponding author
Gershon, Andrea S.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2014-09-17
Volume
312
Issue
11
Pages
1114
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2014.11432
OpenAlex
W2101134637
Cited by
121
References
29
Citations by year
2025: 1 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 10 · 2020: 7 · 2019: 19 · 2018: 16 · 2017: 9 · 2016: 20 · 2015: 20 · 2014: 7
FWCI
14.95
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research (88591_1)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Inhalation and Respiratory Drug Delivery
Keywords
chronic obstructive pulmonary disease, long-acting beta2-agonists, inhaled corticosteroids, combination therapy, older adults, COPD hospitalization, mortality, asthma comorbidity, real-world effectiveness, COPD exacerbation prevention, health care utilization, prescription drug use, propensity score matching, administrative health data, cost-effectiveness
MeSH terms
Administration, Inhalation, Adrenal Cortex Hormones, Adrenergic beta-Agonists, Aged, Aged, 80 and over, Asthma, Drug Therapy, Combination, Female, Hospitalization, Humans, Longitudinal Studies, Male, Risk, Pulmonary Disease, Chronic Obstructive

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