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- Title
Inhaled Medication Use in SmokersWith Normal Spirometry.
- Authors
Arnold, Nicholas R.; Wan, Emily S.; Hersh, Craig P.; Schwartz, Andrei; Kinney, Greg; Young, Kendra; Hokanson, John; Regan, Elizabeth A.; Comellas, Alejandro P.; Fortis, Spyridon
- 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 b 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 5 .003), numerous medical comorbidities, radiographic emphysema (OR 2.22, P 5 .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 5 .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.
- Subjects
UNITED States; ADRENOCORTICAL hormones; CONFIDENCE intervals; ASTHMA; MULTIVARIATE analysis; RETROSPECTIVE studies; RESPIRATORY measurements; MANN Whitney U Test; FISHER exact test; BRONCHODILATOR agents; SEX distribution; DYSPNEA; T-test (Statistics); OBSTRUCTIVE lung diseases; DESCRIPTIVE statistics; QUESTIONNAIRES; FORCED expiratory volume; CHI-squared test; RESEARCH funding; INHALATION administration; SMOKING; SPIROMETRY; ODDS ratio; LOGISTIC regression analysis; DATA analysis software; DISEASE exacerbation; COMORBIDITY; PULMONARY emphysema; CHRONIC bronchitis
- Publication
Respiratory Care, 2021, Vol 66, Issue 4, p652
- ISSN
0020-1324
- Publication type
Article
- DOI
10.4187/respcare.08016