Journal article
Inhaled Medication Use in Smokers With Normal Spirometry
Respiratory care, Vol.66(4), pp.652-660
04/2021
DOI: 10.4187/respcare.08016
PMCID: PMC9993991
PMID: 33563793
Abstract
BACKGROUND: The objective of our study was to identify variables associated with inhaled medication use in smokers with normal spirometry (GOLD-0) and to examine the association of inhaled medication use with development of exacerbations and obstructive spirometry in the future.
METHODS: We performed a retrospective multivariable analysis of GOLD-0 subjects identified in data from the COPDGene study to examine factors associated with medication use. Five categories were identified: (1) no medications, (2) short-acting bronchodilator, (3) long-acting bronchodilator; long-acting muscarinic antagonists and/or long-acting β agonist, (4) inhaled corticosteroids (ICS) with or without long-acting bronchodilator, and (5) dual bronchodilator with ICS. Sensitivity analysis was performed excluding subjects with history of asthma. We also evaluated whether long-acting inhaled medication use was associated with exacerbations and obstructive spirometry at the follow-up visit 5 y after enrollment.
RESULTS: Of 4,303 GOLD-0 subjects within the analysis, 541 of them (12.6%) received inhaled medications. Of these, 259 (6%) were using long-acting inhaled medications and 282 (6.6%) were taking short-acting bronchodilator. Female sex (odds ratio [OR] 1.47, P = .003), numerous medical comorbidities, radiographic emphysema (OR 2.22, P = .02), chronic bronchitis (OR 1.77, P < .001), dyspnea (OR 2.24, P < .001), asthma history (OR 15.56, P < .001), prior exacerbation (OR 8.45, P < .001), and 6-min walk distance (OR 0.9, P < .001) were associated with medication use. Minimal changes were noted in a sensitivity analysis. Additionally, inhaled medications were associated with increased total (incidence rate ratio 2.83, P < .001) and severe respiratory exacerbations (incidence rate ratio 3.64, P < .001) and presence of obstructive spirometry (OR 2.83, P = .002) at follow-up.
CONCLUSIONS: Respiratory symptoms, history of asthma, and radiographic emphysema were associated with inhaled medication use in smokers with normal spirometry. These individuals were more likely to develop obstructive spirometry, which suggests that health care providers may be able to identify obstructive lung disease prior to meeting the current criteria for COPD.
Details
- Title: Subtitle
- Inhaled Medication Use in Smokers With Normal Spirometry
- Creators
- Nicholas R. Arnold - Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IowaEmily S Wan - Jamaica Plain Campus, VA Boston Health Care System, Boston, MassachusettsCraig P Hersh - Brigham and Women's HospitalAndrei Schwartz - University of IowaGreg Kinney - University of Colorado DenverKendra Young - University of Colorado DenverJohn Hokanson - Colorado School of Public HealthElizabeth A Regan - National Jewish HealthAlejandro P Comellas - Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IowaSpyridon Fortis - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Respiratory care, Vol.66(4), pp.652-660
- DOI
- 10.4187/respcare.08016
- PMID
- 33563793
- PMCID
- PMC9993991
- NLM abbreviation
- Respir Care
- ISSN
- 0020-1324
- eISSN
- 1943-3654
- Grant note
- IK2 RX002165 / RRD VA
- Language
- English
- Date published
- 04/2021
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Psychiatry; ICTS; Internal Medicine
- Record Identifier
- 9984359792402771
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