Polypharmacy in patients hospitalised for acute exacerbation of COPD

Díez-Manglano, Jesús; Barquero-Romero, José; Mena, Pedro Almagro; Iglesias, J.; Cabrera-Aguilar, J.; López-García, Francisco; Boixeda, Ramón; Soriano, Joan B.; Researchers, Ecco Study

doi:10.1183/09031936.00014814

Cited by 23 publications

(22 citation statements)

References 15 publications

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“…Moreover, participants in GOLD grade 4 were prescribed higher number of COPD medications compared to their counterparts in GOLD grades 1 and 2. This finding is consistent with previous reports indicating similar associations between increase in number of respiratory medications with severity of airflow limitation based on FEV 1 % predicted36 and GOLD grades 37. Our study has also revealed that participants in GOLD quadrant D had the most complex COPD-specific pharmacotherapy in all the three aspects of MRCI, especially when compared with those in quadrants A and B, even though they were taking a similar number of COPD medications as participants in all the other GOLD quadrants.…”

Section: Discussionsupporting

confidence: 93%

“…It is interesting to note that participants in our study were taking a higher number of medications compared to both slightly younger (median 62.7 [61.7, 63.8] years)42 and older (mean [SD] 73.7 [8.9] years)36 COPD patients in other studies. In our cohort, the median total MRCI score for all medications was 24 (18.5, 31).…”

Section: Discussionmentioning

confidence: 68%

“…While similar previous studies in COPD mainly investigated the relationships between medication count and clinical outcomes only,36,37 to the best of our knowledge, the present study is the first to describe the relationships of COPD outcomes, comorbidities, and multidimensional indices with medication burden beyond medication count.…”

Section: Discussionmentioning

confidence: 81%

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Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Negewo¹,

Gibson

Wark

et al. 2017

COPD

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BackgroundCOPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug–drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown.ObjectivesThe aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices.MethodsIn a cross-sectional study, COPD patients (n=222) were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI).ResultsParticipants (58.6% males) had a mean (SD) age of 69.1 (8.3) years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4) and a median of five comorbidities. The median (q1, q3) total MRCI score was 24 (18.5, 31). COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; P<0.0001). Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15.5) compared to those in quadrants A (13.5; P=0.0001) and B (12.5; P<0.0001). Increased complexity of COPD-specific treatments showed significant but weak correlations with lower lung function and 6-minute walk distance, higher St George’s Respiratory Questionnaire and COPD assessment test scores, and higher number of prior year COPD exacerbations and hospitalizations. Comorbid cardiovascular, gastrointestinal, or metabolic diseases individually contributed to higher total MRCI scores and/or medication counts for all medications. Charlson Comorbidity Index and COPD-specific comorbidity test showed the highest degree of correlation with total MRCI score (ρ=0.289 and ρ=0.326; P<0.0001, respectively).ConclusionIn COPD patients, complex medication regimens are associated with disease severity and specific class of comorbidities.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 68%

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Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Negewo¹,

Gibson

Wark

et al. 2017

COPD

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“…Additionally, because hypertension, diabetes mellitus and chronic kidney disease are strongly related to cardiovascular diseases, patients with these comorbidities often receive additional drugs recommended in both primary and secondary prevention (e.g. aspirin, statins) [19,[42][43][44]. The association of these cardiovascular risk factors and cardiovascular diseases with polypharmacy is consistent with previous data [13,45].…”

Section: Discussionsupporting

confidence: 74%

Polypharmacy and specific comorbidities in university primary care settings

Aubert¹,

Streit²,

Costa³

et al. 2016

European Journal of Internal Medicine

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“…The altered oxidant balance during COPD may deplete the endogenous antioxidant defence leading to oxidation of cellular components and molecules within the lung, adipose tissue and skeletal muscle sustaining their roles in systemic inflammation. Polypharmacy is a major issue commonly encountered in COPD patients, as all the comorbidities and syndromes are treated in isolation (Diez-Manglano et al, 2014;Franssen, Spruit, & Wouters, 2011). This means that the risk of adverse events due to combining drugs is increased and compliance may become difficult particularly in elderly/frail group of patients.…”

Section: Perspectives and Conclusionmentioning

confidence: 99%

Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies

Chan

Selemidis

Bozinovski

et al. 2019

Pharmacology & Therapeutics

104

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a b s t r a c t a r t i c l e i n f oChronic obstructive pulmonary disease (COPD) is a major incurable global health burden and is currently the 4th largest cause of death in the world. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction) and infective viral and bacterial acute exacerbations (AECOPD). Current pharmacological treatments for COPD are relatively ineffective and the development of effective therapies has been severely hampered by the lack of understanding of the mechanisms and mediators underlying COPD. Since comorbidities have a tremendous impact on the prognosis and severity of COPD, the 2015 American Thoracic Society/European Respiratory Society (ATS/ERS) Research Statement on COPD urgently called for studies to elucidate the pathobiological mechanisms linking COPD to its comorbidities. It is now emerging that up to 50% of COPD patients have metabolic syndrome (MetS) as a comorbidity. It is currently not clear whether metabolic syndrome is an independent co-existing condition or a direct consequence of the progressive lung pathology in COPD patients. As MetS has important clinical implications on COPD outcomes, identification of disease mechanisms linking COPD to MetS is the key to effective therapy. In this comprehensive review, we discuss the potential mechanisms linking MetS to COPD and hence plausible therapeutic strategies to treat this debilitating comorbidity of COPD.

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Polypharmacy in patients hospitalised for acute exacerbation of COPD

Cited by 23 publications

References 15 publications

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Polypharmacy and specific comorbidities in university primary care settings

Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies

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