Go to content

Medication discontinuation in adults with COPD discharged from the hospital: a population-based cohort study


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.



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.

View Source

Contributing ICES Scientists

Associated Sites