Inhaled pharmacotherapy and stroke risk in patients with chronic obstructive pulmonary disease: A nationwide population based study using two-stage approach

Hui Wen Lin, Chi Li Chung, You Shuei Lin, Chia Ming Yu, Chun-Nin Lee, Mauo Ying Bien

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background and Purpose Patients with chronic obstructive pulmonary disease (COPD) are at higher risk of stroke than those without COPD. This study aims to explore the impact of inhaled pharmacotherapy on stroke risk in COPD patients during a three-year follow-up, using a nationwide, population- based study and a matched cohort design. Methods The study cohort comprised 10,413 patients who had received COPD treatment between 2004 and 2006; 41,652 randomly selected subjects comprised the comparison cohort. Cox proportional hazard regressions and two-stage propensity score calibration were performed to determine the impact of various inhaled therapies including short-acting muscarinic antagonists, long-acting muscarinic antagonists, short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), and LABA plus inhaled corticosteroid (ICS), on the risk after adjustment for patient demographic characteristics and comorbid disorders. Results Of the 52,065 sampled patients, 2,689 (5.2%) developed stroke during follow-up, including 727 (7.0%) from the COPD cohort and 1,962 (4.7%) from the comparison cohort (p <0.001). Treatment with SABA was associated with 1.67-fold (95% CI 1.45-1.91; p <0.001) increased risk of stroke in COPD patients. By contrast, the cumulative incidence of stroke was significantly lower in those treated with LABA plus ICS than those treated without (adjusted hazard ratio 0.75, 95% CI 0.60-0.94, p = 0.014). Conclusions Among COPD patients, the use of inhaled SABA is associated with an increased risk of stroke, and combination treatment with inhaled LABA and ICS relates to a risk reduction. Further prospective research is needed to verify whether LABA plus ICS confers protection against stroke in patients with COPD.

Original languageEnglish
Article numbere0130102
JournalPLoS One
Volume10
Issue number7
DOIs
Publication statusPublished - Jul 9 2015

Fingerprint

Drug therapy
Pulmonary diseases
stroke
respiratory tract diseases
Chronic Obstructive Pulmonary Disease
Stroke
Drug Therapy
adrenal cortex hormones
Population
Adrenal Cortex Hormones
Muscarinic Antagonists
agonists
antagonists
Hazards
Risk Adjustment
Propensity Score
sociodemographic characteristics
risk reduction
Risk Reduction Behavior
Therapeutics

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Inhaled pharmacotherapy and stroke risk in patients with chronic obstructive pulmonary disease : A nationwide population based study using two-stage approach. / Lin, Hui Wen; Chung, Chi Li; Lin, You Shuei; Yu, Chia Ming; Lee, Chun-Nin; Bien, Mauo Ying.

In: PLoS One, Vol. 10, No. 7, e0130102, 09.07.2015.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose Patients with chronic obstructive pulmonary disease (COPD) are at higher risk of stroke than those without COPD. This study aims to explore the impact of inhaled pharmacotherapy on stroke risk in COPD patients during a three-year follow-up, using a nationwide, population- based study and a matched cohort design. Methods The study cohort comprised 10,413 patients who had received COPD treatment between 2004 and 2006; 41,652 randomly selected subjects comprised the comparison cohort. Cox proportional hazard regressions and two-stage propensity score calibration were performed to determine the impact of various inhaled therapies including short-acting muscarinic antagonists, long-acting muscarinic antagonists, short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), and LABA plus inhaled corticosteroid (ICS), on the risk after adjustment for patient demographic characteristics and comorbid disorders. Results Of the 52,065 sampled patients, 2,689 (5.2{\%}) developed stroke during follow-up, including 727 (7.0{\%}) from the COPD cohort and 1,962 (4.7{\%}) from the comparison cohort (p <0.001). Treatment with SABA was associated with 1.67-fold (95{\%} CI 1.45-1.91; p <0.001) increased risk of stroke in COPD patients. By contrast, the cumulative incidence of stroke was significantly lower in those treated with LABA plus ICS than those treated without (adjusted hazard ratio 0.75, 95{\%} CI 0.60-0.94, p = 0.014). Conclusions Among COPD patients, the use of inhaled SABA is associated with an increased risk of stroke, and combination treatment with inhaled LABA and ICS relates to a risk reduction. Further prospective research is needed to verify whether LABA plus ICS confers protection against stroke in patients with COPD.",
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