Inhaled Medication Use in Smokers With Normal Spirometry

Overview

Journal Respir Care

Publisher Mary Ann Liebert

Specialty Pulmonary Medicine

Date 2021 Feb 10

PMID 33563793

Citations 1

Authors

Nicholas R Arnold

Emily S Wan

Craig P Hersh

Andrei Schwartz

Greg Kinney

Kendra Young

John Hokanson

Elizabeth A Regan

Alejandro P Comellas

Spyridon Fortis

Affiliations

Soon will be listed here.

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, = .003), numerous medical comorbidities, radiographic emphysema (OR 2.22, = .02), chronic bronchitis (OR 1.77, < .001), dyspnea (OR 2.24, < .001), asthma history (OR 15.56, < .001), prior exacerbation (OR 8.45, < .001), and 6-min walk distance (OR 0.9, < .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, < .001) and severe respiratory exacerbations (incidence rate ratio 3.64, < .001) and presence of obstructive spirometry (OR 2.83, = .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.

Citing Articles

Risk factors of acute exacerbation and disease progression in young patients with COPD.

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PMID: 39019624 PMC: 11256056. DOI: 10.1136/bmjresp-2023-001740.

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