Short-Acting Beta-Agonists, Antibiotics, Oral Corticosteroids, and the Associated Burden of COPD

Abstract

Background

Severe acute exacerbations of COPD (AECOPDs) are key events that drive health care resource use (HCRU) and negatively impact patients’ quality of life.

Research Question

What is the real-world burden of COPD relative to patients’ medication history, specifically, exposure to short-acting beta-agonists (SABAs), antibiotics, and oral corticosteroids (OCSs)?

Study Design and Methods

A population-based retrospective cohort study was conducted of patients in Alberta, Canada, identified as having COPD based on administrative health care data (April 1, 2011-March 31, 2019). The risk of severe AECOPDs over 90 days (COPD events resulting in hospitalization or ED visits) and COPD-specific HCRU were studied relative to prior-year SABA, antibiotic, and OCS history.

Results

One hundred eighty-eight thousand nine hundred sixty-nine patients identified with COPD were identified (mean ± SD age, 68.8 ± 13.0 years). After controlling for age, sex, calendar year at index, comorbidities at index, and prior severe AECOPDs, patients with frequent SABA, antibiotic, or OCS exposure in a given year showed significantly higher 90-day risks of severe AECOPDs in a positively associated relationship. Patients with the highest SABA exposure (≥ 6 canisters in a given year) showed twice the rate of severe AECOPDs as patients with 1 SABA canister (incidence rate ratio [IRR], 2.06; 95% CI, 2.01-2.11). The 90-day rates of severe AECOPDs were 51% higher for patients with ≥ 6 vs 1 to 2 antibiotic dispensations (IRR, 1.51; 95% CI, 1.48-1.55) and 3% higher for patients with ≥ 6 vs 1 to 5 OCS burst days (IRR, 1.03; 95% CI, 1.00-1.06). Mean annualized rates of hospitalization and ED visits were highest for patients dispensed ≥ 6 (vs fewer) SABA canisters or antibiotics and patients with any OCS burst days in a given year.

Interpretation

Histories of frequent or prolonged exposure to SABAs, antibiotics, or OCSs were associated with higher rates of severe AECOPDs and HCRU.