COPD hospitalization may increase risk for medication discontinuation
Patients admitted to the hospitalization for chronic obstructive pulmonary disease are at increased risk for discontinuation of long-acting inhaler medications upon discharge and transition to home, according to results published in CHEST.
Andrea S. Gershon, MD, MSc, scientist at Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences, respirologist in the division of respirology at Sunnybrook Health Sciences Center and associate professor of medicine at the University of Toronto, Ontario, and colleagues conducted a population-based, retrospective, cohort study of 78,953 adults with COPD aged 66 years and older who had a prescription for a long-acting muscarinic antagonist or long-acting beta-agonist and inhaled corticosteroid continuously for 1 year or longer. The researchers assessed health administrative data from 2004 to 2016 to assess risk for medication discontinuation following hospitalization for COPD.
The primary outcome was medication discontinuation, which the researchers defined as nonreceipt of the medication the patient was continuously taking within 90 days following index date.
Among 69,253 continuous LAMA users and 36,439 continuous LABA-ICS users, the researchers reported 18,330 and 9,283 hospitalization episodes, respectively. Patients who had been hospitalized had a higher risk for medication discontinuation compared with patients who were not hospitalized; the adjusted risk ratio for patients continuously taking a LAMA was 1.5 (95% CI, 1.34-1.67; P <.001) and the aRR for those continuously taking a LABA-ICS was 1.62 (95% CI, 1.39-1.90; P <.001). For continuous LAMA users, the crude rate of discontinuation was 5.2% in the hospitalized group vs. 3.3% in patients who were not hospitalized. For continuous LABA-ICS users, the crude rate of discontinuation was 5.5% vs. 3.1%, respectively.
Due to the importance of appropriate pharmacotherapy in COPD management, these results should be confirmed and quantified in a prospective cohort of average COPD patients in real-world transitions, according to the researchers.
“Transitions between health care settings may exacerbate risks to patient safety. We found that older adults with COPD had an elevated risk of having their long-acting bronchodilator medications unintentionally discontinued following hospitalization,” Gershon told Healio. “Considering the adverse health outcomes that may be associated with gaps in drug continuity, these findings underscore a need for standardized practices to prevent medication errors at hospital discharge in the COPD population.”
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Andrea Gershon, MD, MSc, can be reached at email@example.com.