Cardiovascular Medication Use and Risk of Acute Exacerbation in Patients With Asthma-COPD Overlap (CVACO Study)

Vincent Yi-Fong Su; Szu-Wen Ko; Yuh-Lih Chang; Yueh-Ching Chou; Hsin-Chen Lee; Kuang-Yao Yang; Kun-Ta Chou; Chia-Chen Hsu

doi:10.4168/aair.2022.14.3.314

Cardiovascular Medication Use and Risk of Acute Exacerbation in Patients With Asthma-COPD Overlap (CVACO Study)

Allergy Asthma Immunol Res. 2022 May;14(3):314-327. doi: 10.4168/aair.2022.14.3.314.

Authors

Vincent Yi-Fong Su^{1

2

3}, Szu-Wen Ko^{4

5}, Yuh-Lih Chang^{4

5

6}, Yueh-Ching Chou^{4

5

6

7}, Hsin-Chen Lee⁵, Kuang-Yao Yang^{2

3

8

9}, Kun-Ta Chou^{2

3

10}, Chia-Chen Hsu^{4

11}

Affiliations

¹ Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan.
² Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
³ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁷ School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
⁸ Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁹ Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁰ Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹¹ Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan. cchsu6@vghtpe.gov.tw.

Abstract

Purpose: Current clinical guidelines are unclear regarding the association of cardiovascular medication with the risk of acute exacerbation (AE) in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO).

Methods: We conducted a retrospective cohort study by interrogating the claims database of Taipei Veterans General Hospital. Patients with coexistent fixed airflow limitation and asthma were enrolled as an ACO cohort between 2009 and 2017. Exposure to cardiovascular medications, including angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), non-selective beta-blockers, cardioselective beta-blockers, dihydropyridine (DHP) calcium channel blockers (CCBs), and non-DHP CCBs, in 3-month period each served as time-dependent covariates. Patients receiving a cardiovascular medication ≥ 28 cumulative daily doses were defined as respective cardiovascular medication users. Patients were followed up until December 31, 2018. The primary endpoint was severe AE, defined as hospitalization or emergency department visit for either asthma, COPD, or respiratory failure. The secondary outcome was moderate AE.

Results: The final study cohort consisted of 582 ACO subjects, with a mean follow-up period of 2.98 years. After adjustment, ARB (hazard ratio [HR], 0.64, 95% confidence interval [CI], 0.44-0.93, P = 0.019), cardioselective beta-blocker (HR, 0.29, 95% CI, 0.11-0.72, P = 0.008) and DHP CCB (HR, 0.66, 95% CI, 0.45-0.97, P = 0.035) therapies were associated with lower risks of severe AE. ARB (HR, 0.42, 95% CI, 0.30-0.62, P < 0.001) and DHP CCB (HR, 0.55, 95% CI, 0.38-0.80, P = 0.002) therapies were associated with lower risks of moderate AE. Cardioselective beta-blockers, ARBs, and DHP CCBs were associated with lower risks of severe AE in frequent exacerbators. ACEI, non-selective beta-blocker, or non-DHP CCB use did not change the risk of severe AE.

Conclusions: ARB, cardioselective beta-blocker, and DHP CCB therapies may lower the risk of AE in patients with ACO.

Keywords: Asthma; angiotensin II receptor blockers; angiotensin converting enzyme inhibitors; beta-adrenergic blockers; calcium channel blockers; chronic obstructive pulmonary disease.

Abstract

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