Long-acting bronchodilators in patients with chronic obstructive pulmonary disease (COPD) are often held at hospital admission and not restarted at discharge, according to recent research.
Researchers performed a retrospective cohort study using health administrative data from 2004 to 2016 in Ontario, Canada, to determine the risk of unintentional discontinuation of long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination therapy after hospital discharge in older adults with COPD. Patients with COPD who were ages 66 years and older and who had filled LAMA or LABA-ICS prescriptions continuously for at least one year were included and were categorized as having been hospitalized, having visited the ED, or neither. The study's primary outcome was medication discontinuation, defined as nonreceipt of the medication that the patient had been regularly taking within 90 days after the index date, in those who were hospitalized versus those who were not. Results were published Oct. 1 by CHEST.
Overall, 27,613 hospitalizations and 56,057 ED visits in 78,953 patients who had COPD and were highly adherent to medications were included in the study. A total of 18,330 hospitalizations occurred among 69,253 patients continuously using LAMAs, and 9,283 occurred among 36,439 continuous users of LABA-ICS. COPD medications were discontinued 1,466 times among 27,613 discharges. Patients who were hospitalized were at higher risk for medication discontinuation than those who remained in the community (adjusted risk ratios, 1.50 [95% CI, 1.34 to 1.67] for LAMAs and 1.62 [95% CI, 1.39 to 1.90] for LABA-ICS; P<0.001 for both comparisons). Crude rates of discontinuation were 5.2% and 3.3% in the hospitalization group and the community group, respectively, for LAMAs and 5.5% and 3.1%, respectively, for LABA-ICS.
The authors noted that their study was observational and that not all potential causes of medication interruption could be considered, among other limitations. They concluded that based on their results, older adults with COPD who are highly adherent to medications are at risk for unintentional discontinuation of long-acting bronchodilators after hospitalization. “Considering the adverse health outcomes that may be associated with gaps in drug continuity, these findings underscore a need for further prospective clinical study in average, less adherent COPD patients as well as standardized practices to prevent medication errors at hospital discharge in the COPD population,” the authors wrote. “Future studies should also study medication overuse as well.” They noted that quality improvement efforts should focus on safe transitions and on medication reconciliation after discharge.