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Parkin L, Williams S, Sharples K, Barson D, Horsburgh S, Jackson R, Wu B, Dummer J. Dual versus single long-acting bronchodilator use could raise acute coronary syndrome risk by over 50%: A population-based nested case-control study. J Intern Med 2021; 290:1028-1038. [PMID: 34289189 PMCID: PMC8596666 DOI: 10.1111/joim.13348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coronary heart disease occurs more frequently among patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. While some research suggests that long-acting bronchodilators might confer an additional risk of acute coronary syndrome (ACS), information from real-world clinical practice about the cardiovascular impact of using two versus one long-acting bronchodilator for COPD is limited. We undertook a population-based nested case-control study to estimate the risk of ACS in users of both a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist (LABA) relative to users of a LAMA. METHODS The study was based on the primary care PREDICT Cardiovascular Disease Cohort and linked data from regional laboratories and the New Zealand Ministry of Health's national data collections. The underlying cohort (n = 29,993) comprised patients aged 45-84 years, who initiated treatment with a LAMA and/or LABA for COPD between 1 February 2006 and 11 October 2016. 1490 ACS cases were matched to 13,550 controls by date of birth, sex, date of cohort entry (first long-acting bronchodilator dispensing), and COPD severity. RESULTS Relative to current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a significantly higher risk of ACS (adjusted OR = 1.72; [95% CI: 1.28-2.31]). CONCLUSION Dual long-acting bronchodilator therapy, rather than LAMA mono-therapy, could increase the risk of ACS by more than 50%. This has important implications for decisions about the potential benefit/harm ratio of COPD treatment intensification, given the modest benefits of dual therapy.
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Affiliation(s)
- Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.,Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Sheila Williams
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand.,Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.,Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - David Barson
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.,Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.,Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Rod Jackson
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Billy Wu
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jack Dummer
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand.,Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
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2
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Parkin L, Williams S, Barson D, Sharples K, Horsburgh S, Jackson R, Dummer J. Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice? BMJ Open Respir Res 2021; 8:8/1/e000840. [PMID: 33495233 PMCID: PMC7839854 DOI: 10.1136/bmjresp-2020-000840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case-control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA. METHODS We used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity. RESULTS From the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91). CONCLUSION In real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.
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Affiliation(s)
- Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Sheila Williams
- Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - David Barson
- Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
- Department of Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Rod Jackson
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jack Dummer
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
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Axson EL, Lewis A, Potts J, Pang M, Dickinson S, Vioix H, Quint JK. Inhaled therapies for chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMJ Open 2020; 10:e036455. [PMID: 32994234 PMCID: PMC7526304 DOI: 10.1136/bmjopen-2019-036455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To integrate evidence from randomised controlled trials (RCTs) and observational studies on the efficacy of inhaled treatments for chronic obstructive pulmonary disease using network meta-analyses. METHODS Systematic searches MEDLINE and Embase based on predetermined criteria. Network meta-analyses of RCTs investigated efficacy on exacerbations (long-term: ≥20 weeks of treatment; short-term: <20 weeks), lung function (≥12 weeks), health-related quality of life, mortality and adverse events. Qualitative comparisons of efficacies between RCTs and observational studies. RESULTS 212 RCTs and 19 observational studies were included. Compared with combined long-acting beta-adrenoceptor agonists and long-acting muscarinic antagonists (LABA+LAMA), triple therapy (LABA+LAMA+inhaled corticosteroid) was significantly more effective at reducing exacerbations (long-term 0.85 (95% CI: 0.78 to 0.94; short-term 0.67 (95% CI: 0.49 to 0.92)) and mortality (0.72 (95% CI: 0.59 to 0.89)) but was also associated with increased pneumonia (1.35 (95% CI: 1.10 to 1.67)). No differences in lung function (0.02 (95% CI: -0.10 to 0.14)), health-related quality of life (-1.12 (95% CI: -3.83 to 1.59)) or other adverse events (1.02 (95% CI: 0.96 to 1.08)) were found. Most of the observational evidence trended in the same direction as pooled RCT data. CONCLUSION Further evidence, especially pragmatic trials, are needed to fully understand the characteristics of patient subgroups who may benefit from triple therapy and for those whom the extra risk of adverse events, such as pneumonia, may outweigh any benefits. PROSPERO REGISTRATION NUMBER CRD42018088013.
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Affiliation(s)
- Eleanor L Axson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam Lewis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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4
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Wang MT, Lin CW, Tsai CL, Wang YH, Lai JH, Yeh CB, Huang YL, Hsu YJ. Use of antipsychotics and the risk of acute respiratory failure among adults: A disease risk score-matched nested case-control study. Br J Clin Pharmacol 2020; 86:2204-2216. [PMID: 32337738 DOI: 10.1111/bcp.14321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Evidence on acute respiratory failure (ARF) from antipsychotics is scant, and only 1 population-based study examined this drug safety issue in chronic obstructive pulmonary disease patients. Antipsychotics have been frequently prescribed off-label in adults, but whether antipsychotic use carries an increased ARF risk among adult patients is uncertain. METHODS We adopted a nested case-control study analysing 716 493 adults aged ≥20 years, identified from the Taiwan nationwide healthcare claims records between January 2000 and December 2013. Among the study cohort, 7084 adults with ARF and 12,785 disease risk scored-matched randomly selected controls were analysed. Multivariable logistic regression models were employed to estimate odds ratios of ARF with antipsychotic usages. RESULTS Current, recent, and recent past use of antipsychotics was associated with a 2.33-fold (95% confidence interval [CI] = 2.06-2.64), 1.79-fold (95% CI = 1.43-2.25) and 1.41-fold (95% CI = 1.20-1.66) increased risk of ARF, respectively, compared with nonuse, while antipsychotics discontinued >90 days carried no risk. A dose-dependent association was observed with current therapy of antipsychotics (test for trend, P < .001), in which antipsychotic use at >1 defined daily dose yielded the highest risk of 6.53-fold (95% CI = 3.33-12.79). The findings were robust to using carbamazepine as an active comparator. CONCLUSION Antipsychotic use was associated with an increased risk of ARF in adult patients. The risk was dose-dependent and markedly higher with current use of antipsychotic agents at doses of 1 defined daily dose and above, <10% of this cohort. Physicians should be vigilant about any respiratory symptoms in patients currently receiving antipsychotics at such dose.
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Affiliation(s)
- Meng-Ting Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen Wei Lin
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China.,College of Pharmacy, University of Minnesota, Duluth, Minnesota, United States
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, Republic of China
| | - Yun-Han Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Jyun-Heng Lai
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taiwan, Republic of China
| | - Ya-Ling Huang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institutes of Medical Sciences and Biochemistry, National Defense Medical Center, Taipei, Taiwan, Republic of China
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5
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Lin TH, Chen SI, Su YC, Lin MC, Lin HJ, Huang ST. Conventional Western Treatment Combined With Chinese Herbal Medicine Alleviates the Progressive Risk of Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Retrospective Cohort Study. Front Pharmacol 2019; 10:987. [PMID: 31572178 PMCID: PMC6753872 DOI: 10.3389/fphar.2019.00987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022] Open
Abstract
Background and purpose: Lung cancer has high global incidence and mortality rates. Chronic obstructive pulmonary disease (COPD) is strongly associated with lung cancer and is an independent risk factor for lung cancer with or without smoking. Chinese herbal medicines (CHMs) are used to treat COPD. This study sought to determine whether CHM treatment effectively decreases the incidence of lung cancer in COPD patients receiving conventional Western medical treatment. Methods: Records obtained from the National Health Insurance Research Database (NHIRD) were used to identify 81,780 adults aged ≥18 years newly diagnosed with COPD in Taiwan between 2000 and 2010. Among them, 11,180 received CHMs after COPD diagnosis and 23,319 did not (non-CHM). After excluding patients with missing basic demographic information, each group consisted of 2,682 patients. Statistical methods analyzed the baseline characteristics for both groups and we performed a Cox proportional hazard regression analysis to examine the incidence of lung cancer. The cumulative incidence of lung cancer in COPD patients with or without CHM treatment was calculated by the Kaplan-Meier method. The association between herbs and formulas was examined by NodeXL to perform a network analysis of CHM. Results: COPD patients using CHM had a lower risk for lung cancer (adjusted hazards ratio [aHR] = 0.36, 95% confidence interval [CI] = 0.24–0.53, p < 0.001). Older age was associated with a higher risk of lung cancer: patients aged 40–59 years (aHR = 5.32, 95% CI = 2.19–12.94, p < 0.001) and those aged ≥60 years (aHR = 16.75, 95% CI = 7.54–37.23, p < 0.001) were at significantly greater risk compared with patients aged 18–39 years. CHM use was associated with a trend for a lower cumulative incidence of lung cancer compared with non-CHM use (p < 0.001). Among the 10 most commonly used single herbs and formulas used to decrease the risk of lung cancer in COPD patients, Fritillariae thunbergii was the most commonly used single herb and Xiao Qing Long Tang the most commonly used formula. Conclusion: The findings from this nationwide retrospective cohort study indicate that CHM as adjunctive therapy in COPD treatment regimens may reduce the risk of lung cancer in this vulnerable patient population.
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Affiliation(s)
- Tsai-Hui Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shu-I Chen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.,Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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6
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Wang MT, Lai JH, Tsai CL, Liou JT. Risk of adverse cardiovascular events with use of inhaled long-acting bronchodilators in management of chronic obstructive pulmonary disease. J Food Drug Anal 2019; 27:657-670. [PMID: 31324282 PMCID: PMC9307027 DOI: 10.1016/j.jfda.2018.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023] Open
Abstract
Inhaled long-acting bronchodilators, including long-acting β2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are the mainstay therapy in the treatment of chronic obstructive pulmonary disease (COPD), a disease that poses a heavy burden on morbidity and mortality worldwide. Use of LABAs and LAMAs in patients with COPD, however, has been concerned about an increased risk of adverse cardiovascular events, despite inconsistent findings reported from randomized controlled trials (RCTs) and observational studies. In this review, we detailed the relevant evidence generated from RCTs and observational studies with respect to the risk of cardiovascular disease with use of LABAs and LAMAs in management of COPD, and analyzed the contradictory findings in the literature, as well as recommended future research directions to clear the air regarding the cardiovascular safety of inhaled long-acting bronchodilators.
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Affiliation(s)
- Meng-Ting Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
| | - Jyun-Heng Lai
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Jun-Ting Liou
- Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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7
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Liou JT, Lin CW, Tsai CL, Wang YH, Lai JH, Hsu YJ, Wang MT. Risk of Severe Cardiovascular Events From Add-On Tiotropium in Chronic Obstructive Pulmonary Disease. Mayo Clin Proc 2018; 93:1462-1473. [PMID: 30104044 DOI: 10.1016/j.mayocp.2018.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/28/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the risk of cardiovascular disease (CVD) from tiotropium added to inhaled long-acting β2 agonists (LABAs) and inhaled corticosteroids (ICSs) in a nationwide population with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS This nested case-control study included 65,966 patients with COPD treated with LABAs and ICSs identified from the Taiwan nationwide health care claims database from January 1, 2007, through June 30, 2011. Cases were all patients with a first primary diagnosis of ischemic heart disease, heart failure, stroke, or arrhythmia from inpatient or emergency care settings during follow-up, and each was matched with 4 disease risk score-matched controls from risk sets. The use of tiotropium in the year before the index/event date was measured, stratified by duration since therapy initiation, concomitant COPD medications, and dosage form. Conditional logistic regression models were used to estimate odds ratios of the CVD risk from add-on tiotropium therapy. RESULTS From the study cohort, with a mean age of 70.3 years (interquartile range, 61.8-79.4 years), 3188 CVD cases (incidence rate, 6.2 [95% CI, 6.0-6.4] cases per 100 person-years) and 12,349 matched controls were identified. The new use of tiotropium was associated with a 1.88-fold (95% CI, 1.44-2.46) increased CVD risk within 30 days of therapy initiation, and the association was sustained up to 60 days after treatment initiation (adjusted odds ratio, 1.71; 95% CI, 1.08-2.70). The risk persisted across all tiotropium regimens, with a case-crossover analysis, and in comparison with new add-on theophylline therapy. CONCLUSION Tiotropium newly added to LABA/ICS combination therapy was associated with an increased cardiovascular risk in patients with COPD.
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Affiliation(s)
- Jun-Ting Liou
- Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen Wei Lin
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yun-Han Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Jyun-Heng Lai
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institutes of Medical Sciences and Biochemistry, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Meng-Ting Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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8
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CD30 Is Highly Expressed in Chronic Obstructive Pulmonary Disease and Induces the Pulmonary Vascular Remodeling. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3261436. [PMID: 29984229 PMCID: PMC6015698 DOI: 10.1155/2018/3261436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the common and underdiagnosed diseases with the highest morbidity and mortality in the world. The development of COPD can lead to pulmonary vascular remodeling and pulmonary hypertension, further causing the occurrence of pulmonary heart disease. Therefore, attenuation of pulmonary vascular remodeling and pulmonary hypertension caused by COPD can significantly delay cardiovascular complications. In the study, we firstly found that the expression of CD30 and CD30L was increased in COPD. Importantly, the serum CD30L levels were significantly higher in patients with stable COPD relative to those with acute exacerbation of COPD (AECOPD). This suggested that CD30 might be related to the development of COPD. In addition, we found that the expression of CD30 in the COPD rat model was significantly increased compared with control group. And treatment with the anti-CD30 antibody reduced the serum concentration and tissue expression of CD30 in rat. Importantly, anti-CD30 antibody alleviated pulmonary vascular remodeling in COPD model rats. This suggested that CD30 played an important role in the course of COPD. Finally, we found that, in the HPASMC and HPAEC cell lines, CD30 can affect the cell viability and cell migration and inhibited hypoxia-induced cell apoptosis in a concentration-dependent manner. We also found CD30 induced extracellular matrix formation through decreasing the expression of MMP-2, thus promoting the pulmonary vascular remodeling. The study indicated that CD30 and CD30L were involved in pulmonary vascular remodeling and inflammatory response in COPD. Altogether, CD30 might be a marker for the early diagnosis and progression of COPD.
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9
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Liao KM, Lin TY, Huang YB, Kuo CC, Chen CY. The evaluation of β-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study. Int J Chron Obstruct Pulmon Dis 2017; 12:2573-2581. [PMID: 28894360 PMCID: PMC5584777 DOI: 10.2147/copd.s141694] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE β-Blockers are safe and improve survival in patients with both congestive heart failure (CHF) and COPD. However, the superiority of different types of β-blockers is still unclear among patients with CHF and COPD. The association between β-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different β-blockers in patients with concurrent CHF and COPD. PATIENTS AND METHODS We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were >20 years old and were diagnosed with CHF between January 1, 2005 and December 31, 2012. COPD patients included those who had outpatient visit claims ≥2 times within 365 days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of β-blockers in the study population. RESULTS We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR] =0.51, 95% confidence interval [CI] =0.29-0.89; hospitalization rate due to CHF exacerbation: aHR =0.48, 95% CI =0.23-1.00). No association was observed between β-blocker use and COPD exacerbation. CONCLUSION In patients with concurrent CHF and COPD, β-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was found to reduce mortality and CHF exacerbation compared to carvedilol and metoprolol.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan
| | - Tien-Yu Lin
- School of Pharmacy, Kaohsiung Medical University.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
| | - Yaw-Bin Huang
- School of Pharmacy, Kaohsiung Medical University.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
| | | | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
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10
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Lee CH, Choi S, Jang EJ, Kim DW, Yoon HI, Kim YJ, Kim J, Yim JJ, Kim DK. The effects of inhaled respiratory drugs on the risk of stroke: A nested case-control study. Pulm Pharmacol Ther 2016; 40:7-14. [PMID: 27418383 DOI: 10.1016/j.pupt.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/07/2016] [Accepted: 07/09/2016] [Indexed: 11/19/2022]
Abstract
Although there have been concerns that inhaled long-acting muscarinic antagonists increase the risk of stroke, controversies exist. We investigated whether respiratory drugs including long-acting muscarinic antagonists are associated with the risk of stroke. A nested case-control study using the nationwide insurance claims database of the Health Insurance Review and Assessment Service (Seoul, Republic of Korea) was conducted. Overall, 16,354 stroke cases and 74,451 matched (up to 1:5) controls were identified from 809,684 subjects without acute major cardiovascular events in the past year between January 1, 2010, and December 31, 2011. To determine whether the use of inhaled respiratory drugs is associated with the risk of stroke, conditional logistic regression analysis adjusted by comorbidities, cardiovascular drugs and healthcare utilization was performed. After adjusting for covariates, there were no statistically significant effects of the inhaled drugs on stroke incidence, except for inhaled corticosteroids without a long-acting β2-agonists, which was significantly associated with hemorrhagic stroke. Inhaled respiratory medications, including long-acting muscarinic antagonists, did not affect the risk of stroke in the inhaled respiratory drug users.
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Affiliation(s)
- Chang-Hoon Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seongmi Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Department of Statistics, Kyungpook National University College of Natural Sciences, Daegu, Republic of Korea
| | - Eun Jin Jang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Department of Information Statistics, Colloge of Natural Science, Andong National University, Andong, Republic of Korea
| | - Dong-Wook Kim
- Department of Neurology, College of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Ho Il Yoon
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Yun Jung Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Jimin Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Jae-Joon Yim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Melani AS, Sestini P. Safety of long acting muscarinic antagonists: are all these drugs always and equally safe? Curr Med Res Opin 2016; 32:975-7. [PMID: 26789695 DOI: 10.1185/03007995.2016.1145108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Inhaled bronchodilators - such as long-acting muscarinic receptor antagonists (LAMAs) - are central to the pharmacological management of symptomatic chronic obstructive pulmonary disease. LAMAs are considered to be safe drugs at recommended dosages. In the present issue of the Journal safety of umeclidinium, a recently marketed LAMA, at twice the recommended dosage, has been evaluated with good results in a Japanese, COPD population. However, because muscarinic receptors are expressed not only in the lungs but also at the level of heart, digestive and urinary apparatus, the potential exists for LAMAs to cause adverse events related to stimulation of receptors in these organs. Head-to-head and post-marketing vigilance studies are required to determine the profile risk of these drugs, ultimately, and whether differences exist between currently available LAMAs.
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Affiliation(s)
- Andrea S Melani
- a Respiratory Rehabilitation and Pathophysiology Unit, Cardiovascular and Lung Department , Policlinico le Scotte, Azienda Ospedaliera Universitaria Senese , Siena , Italy
| | - Piersante Sestini
- b Respiratory Disease Clinics, Siena University, Policlinico le Scotte, Azienda Ospedaliera Universitaria Senese , Siena , Italy
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Erratum: Long-acting Inhaled Bronchodilator and Risk of Vascular Events in Patients With Chronic Obstructive Pulmonary Disease in Taiwan Population: Erratum. Medicine (Baltimore) 2016; 95:e78fe. [PMID: 31265690 PMCID: PMC4779041 DOI: 10.1097/01.md.0000481354.70978.fe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.1097/MD.0000000000002306.].
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