Utilization Pattern of Bronchodilators among COPD Patients in Taiwan and the Risk of Myocardial Infarction associated with Anticholinergic Agents

• Main Authors: Hao Huang, 黃昊
• Other Authors: Pao-Chu Wu
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/21898813052947403974

碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 104 === Introduction: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. Guideline recommended that the first choice of pharmacotherapy was inhaled bronchodilators. The association between myocardial infarction (MI) and anticholinergic agents were still in debate. The aim of this study was to investigate the prescribing patterns of bronchodilators among COPD patients and evaluate the association between anticholinergic agents and MI. Methods: (1) Prescribing patterns: This cross-sectional study used Health and Welfare Data Science Center (HWDC) database to analyze annual prescribing patterns of bronchodilators in COPD patients from 2008 to 2013. (2) Anticholinergic agents and MI: A nested-case control study was conducted by HWDC database. A cohort of 142,437 COPD patients was identified from 2008 to 2013. Case group was defined the first diagnosis of MI after COPD diagnosis. Any use of anticholinergic agents within 6 months before MI occurred was analyzed. From this cohort, 1,583 cases were matched to 1,583 controls by one-to-one propensity score matching (PSM). PSM was based on gender, age, comorbidities and medication history. Conditional logistic regression was applied to evaluate the odds ratio (OR) for the risk of MI associated with anticholinergic agents. In order to eliminate the potential confounders, OR was adjusted by gender, age, comorbidities and medication history. Results: (1) Prescribing patterns: A total of 143, 133 patients were included in the study. The first three common prescriptions were xanthines, short-acting beta-2 agonists (SABA) and muscarinic antagonists (MA). However, the utilization of xanthine declined with time. Among of all SABA prescriptions, the utilization of oral form was more than inhaled form. (2) Anticholinergic agents and MI: Case group showed an increase risk of MI compared with control group. [aOR = 1.55, 95% confidence interval (CI): 1.29-1.85] Conclusion: Although guideline recommended that inhaled bronchodilator was first choice for treatments, our study showed that the prescription patterns of Taiwan were different. Future research is to investigate the reasons and preferences of prescriptions. The use of anticholinergic agents in COPD patients was associated with the risk of MI. Clinicians should be alert this drug safety issue.