Use of ICS/LABA Combinations or LAMA Is Associated with a Lower Risk of Acute Exacerbation in Patients with Coexistent COPD and Asthma

Vincent Yi-Fong Su; Kuang-Yao Yang; Yao-Hsu Yang; Ying-Huang Tsai; Diahn-Warng Perng; Wei-Juin Su; Kun-Ta Chou; Kang-Cheng Su; Yung-Feng Yen; Pau-Chung Chen

doi:10.1016/j.jaip.2018.01.035

Use of ICS/LABA Combinations or LAMA Is Associated with a Lower Risk of Acute Exacerbation in Patients with Coexistent COPD and Asthma

J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):1927-1935.e3. doi: 10.1016/j.jaip.2018.01.035. Epub 2018 Feb 10.

Authors

Affiliations

¹ Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
² Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: kyyang@vghtpe.gov.tw.
³ Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan.
⁵ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁷ Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁸ Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 29432960
DOI: 10.1016/j.jaip.2018.01.035

Abstract

Background: Based on current guidelines, more research is urgently needed to guide appropriate treatment for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap.

Objective: The objective of this study was to investigate medication effects on acute exacerbation in patients with coexistent COPD and asthma.

Methods: Using Taiwan's National Health Insurance Research Database, we conducted a nationwide population-based study to evaluate medication effects in patients with COPD and asthma. Patients diagnosed with both asthma and COPD between 1997 and 2012 were enrolled as the COPD + asthma cohort. The primary endpoint was acute exacerbation. The definitions of COPD and asthma were validated. The validation study confirmed the accuracy of definitions of COPD (86.2% sensitivity) and asthma (92.0% sensitivity).

Results: The study included 251,398 patients with COPD + asthma and 514,522 patients with COPD alone, with a mean follow-up period of 9.85 years. After adjustment, hazard ratios (HRs) for long-acting muscarinic antagonist (LAMA) and inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA) combinations were lower (time-dependent model, 1 year: LAMA, HR 0.51, 95% confidence interval [CI] 0.49-0.54; ICS/LABA combinations, HR 0.61, 95% CI 0.60-0.62; all P < .0001) than were those for LABAs or ICSs in patients with COPD and asthma.

Conclusions: The use of LAMA or ICS/LABA combinations was associated with a lower risk of acute exacerbation in patients with COPD and asthma in this study.

Keywords: ACO; Asthma; Asthma-COPD overlap; COPD; Exacerbations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Adrenal Cortex Hormones / therapeutic use*
Adrenergic beta-2 Receptor Agonists / therapeutic use*
Aged
Asthma / drug therapy*
Disease Progression*
Female
Humans
Male
Muscarinic Antagonists / therapeutic use*
Pulmonary Disease, Chronic Obstructive / drug therapy*
Risk
Severity of Illness Index

Substances

Adrenal Cortex Hormones
Adrenergic beta-2 Receptor Agonists
Muscarinic Antagonists