Exacerbations, mortality risk, and pharmacotherapy in COPD: Effect of 17 different drug combinations in a cohort of 495 patients.

Abstract

Objective: To assess the association between the severity of recent exacerbations and 90-day mortality risk in chronic obstructive pulmonary disease patients (COPD) with acute symptoms, focusing on the impact of the treatment regimen and involving 17 different drug combinations.

Materials and methods: A longitudinal, retrospective analysis was carried out in 495 hospitalized COPD patients aged 40 - 75 years. Patients' clinical characteristics were recorded and the effects of drug regimens, administered pre and post hospitalization, comprising various combinations of long-acting muscarinic antagonists (LAMA), long-acting beta agonists (LABA), inhaled corticosteroids (ICS), and antibiotics, were compared. A statistical analysis of the primary outcome, 90-day mortality was used to identify patient attributes best predicting mortality.

Results: At discharge, 65% of patients were receiving a 3-drug combination, 33% a 2-drug regimen, and 9% a single-drug therapy. Patients discharged on a 3-drug combination treatment had the lowest 90-day mortality rate (4%) compared to 22% for those treated with single-drug regimens. Multivariate analysis revealed that the risk of death on single-drug therapy was more than 5-fold greater (odds ratio 5.08) than in the case of patients discharged on a multi-drug combination regimen.

Conclusion: Patients treated and discharged from hospital on a multi-drug regimen following recent COPD exacerbations had significantly better 90-day survival than patients discharged on monotherapy. The severity of exacerbations and nature of the pharmacotherapy were the main predictors of mortality and were indicative for the importance of disease assessment and multi-drug treatment strategies.