Nicholas T Vozoris1,2,3, Xuesong Wang4, Peter C Austin4,5, Denis E O'Donnell6, Shawn D Aaron7, Teresa M To4,5, Andrea S Gershon3,4,5,8. 1. Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 2. Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. 3. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 5. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 6. Department of Medicine, Queen's University, Kingston, Ontario, Canada. 7. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. 8. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
AIMS: Diuretic drugs may theoretically improve respiratory health outcomes in chronic obstructive pulmonary disease (COPD) through several possible mechanisms, but they might also lead to respiratory harm. We evaluated the association of incident oral diuretic drug use with respiratory-related morbidity and mortality among older adults with COPD. METHODS: This was a population-based, retrospective cohort study using health administrative data from Ontario, Canada, for the period 2008-2013. We identified adults aged 66 years and older with nonpalliative COPD using a validated algorithm. Respiratory-related morbidity and mortality were evaluated within 30 days of incident oral diuretic drug use compared to nonuse using Cox proportional hazard regression and applying inverse probability of treatment weighting using the propensity score to minimize confounding. RESULTS: Out of 99 766 individuals aged 66 years and older with COPD identified, incident diuretic receipt occurred in 51.7%. Relative to controls, incident diuretic users had significantly increased rates for hospitalization for COPD or pneumonia [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.07-1.40], as well as more emergency room visits for COPD or pneumonia (HR 1.35, 95% CI 1.18-1.56), COPD or pneumonia-related mortality (HR 1.41; 95% CI 1.04-1.92) and all-cause mortality (HR 1.20, 95% CI 1.06-1.35). The increased respiratory-related morbidity and mortality observed were specifically as a result of loop diuretic use. CONCLUSIONS: Incident diuretic drugs, and more specifically loop diuretics, were associated with increased rates of respiratory-related morbidity and mortality among older adults with nonpalliative COPD. Further studies are needed to determine if this association is causative or due to unresolved confounding.
AIMS: Diuretic drugs may theoretically improve respiratory health outcomes in chronic obstructive pulmonary disease (COPD) through several possible mechanisms, but they might also lead to respiratory harm. We evaluated the association of incident oral diuretic drug use with respiratory-related morbidity and mortality among older adults with COPD. METHODS: This was a population-based, retrospective cohort study using health administrative data from Ontario, Canada, for the period 2008-2013. We identified adults aged 66 years and older with nonpalliative COPD using a validated algorithm. Respiratory-related morbidity and mortality were evaluated within 30 days of incident oral diuretic drug use compared to nonuse using Cox proportional hazard regression and applying inverse probability of treatment weighting using the propensity score to minimize confounding. RESULTS: Out of 99 766 individuals aged 66 years and older with COPD identified, incident diuretic receipt occurred in 51.7%. Relative to controls, incident diuretic users had significantly increased rates for hospitalization for COPD or pneumonia [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.07-1.40], as well as more emergency room visits for COPD or pneumonia (HR 1.35, 95% CI 1.18-1.56), COPD or pneumonia-related mortality (HR 1.41; 95% CI 1.04-1.92) and all-cause mortality (HR 1.20, 95% CI 1.06-1.35). The increased respiratory-related morbidity and mortality observed were specifically as a result of loop diuretic use. CONCLUSIONS: Incident diuretic drugs, and more specifically loop diuretics, were associated with increased rates of respiratory-related morbidity and mortality among older adults with nonpalliative COPD. Further studies are needed to determine if this association is causative or due to unresolved confounding.
Authors: Nicholas T Vozoris; Xuesong Wang; Hadas D Fischer; Chaim M Bell; Denis E O'Donnell; Peter C Austin; Anne L Stephenson; Sudeep S Gill; Paula A Rochon Journal: Eur Respir J Date: 2016-07-13 Impact factor: 16.671
Authors: John R Hurst; Jørgen Vestbo; Antonio Anzueto; Nicholas Locantore; Hana Müllerova; Ruth Tal-Singer; Bruce Miller; David A Lomas; Alvar Agusti; William Macnee; Peter Calverley; Stephen Rennard; Emiel F M Wouters; Jadwiga A Wedzicha Journal: N Engl J Med Date: 2010-09-16 Impact factor: 91.245
Authors: Nicholas T Vozoris; Hadas D Fischer; Xuesong Wang; Anne L Stephenson; Andrea S Gershon; Andrea Gruneir; Peter C Austin; Geoffrey M Anderson; Chaim M Bell; Sudeep S Gill; Paula A Rochon Journal: Eur Respir J Date: 2014-04-17 Impact factor: 16.671
Authors: Nicholas T Vozoris; Xuesong Wang; Peter C Austin; Denis E O'Donnell; Shawn D Aaron; Teresa M To; Andrea S Gershon Journal: Br J Clin Pharmacol Date: 2017-12-06 Impact factor: 4.335
Authors: Mirjam Hempenius; Kim Luijken; Anthonius de Boer; Olaf Klungel; Rolf Groenwold; Helga Gardarsdottir Journal: Pharmacoepidemiol Drug Saf Date: 2020-05-11 Impact factor: 2.890