Medication discontinuation in adults with COPD discharged from the hospital: a population-based cohort study
Gershon AS, McGihon RE, Thiruchelvam D, To T, Wu R, Bell CM, Aaron SD; Canadian Respiratory Research Network. Chest. 2021; 159(3):975-84. Epub 2020 Oct 1. DOI: https://doi.org/10.1016/j.chest.2020.09.254
Background — Patients admitted to hospital with chronic obstructive pulmonary disease 1 are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, transitions sometimes result in unintentional discontinuation.
Research Question — What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD?
Study Design and Methods — A retrospective cohort study was conducted using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged 66 years or older who had filled prescriptions for a LAMA or LABA-ICS continuously for one year or more were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort.
Results — Over 27,613 hospitalization discharges, medications were discontinued 1466 times. Among 78,953 COPD patients continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios 1.50 (95% confidence interval (CI) 1.34, 1.67; p-value <.001) and 1.62 (95% CI 1.39, 1.90; p-value <.001) for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2% in the hospitalization group and 3.3% in the community group; for people taking LABA-ICS 5.5 % in the hospitalization group and 3.1% in the community group.
Interpretation — In an observational study of highly adherent COPD patients, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed in a prospective cohort of average COPD patients. Quality improvement efforts should focus on safe transitions and patient medication reconciliation after discharge.