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Cardiovascular Medication Use and Risk of Acute Exacerbation in Patients With Asthma-COPD Overlap (CVACO Study)
Vincent Yi-Fong Su1,2,3, Szu-Wen Ko4,5, Yuh-Lih Chang4,5,6
1Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan.
Insights
Certain cardiovascular medications, including ARBs, cardioselective beta-blockers, and DHP CCBs, may reduce the risk of acute exacerbations in patients with asthma-COPD overlap (ACO). This finding offers potential guidance for managing ACO patients.
Area of Science:
- Pulmonology
- Cardiology
- Pharmacology
Background:
- Asthma-Chronic Obstructive Pulmonary Disease (COPD) overlap (ACO) presents unique management challenges.
- Clinical guidelines lack clarity on the impact of cardiovascular medications on acute exacerbations (AE) in ACO patients.
- Understanding these associations is crucial for optimizing patient care and reducing exacerbation risks.
Purpose of the Study:
- To investigate the association between various cardiovascular medications and the risk of acute exacerbations (AE) in patients with ACO.
- To provide evidence-based insights for clinicians managing ACO patients on cardiovascular therapies.
Main Methods:
- Retrospective cohort study utilizing claims data from Taipei Veterans General Hospital (2009-2017).
- ACO patients were identified and followed up for severe and moderate acute exacerbations (AE).
- Time-dependent covariates included exposure to ACEIs, ARBs, non-selective beta-blockers, cardioselective beta-blockers, DHP CCBs, and non-DHP CCBs.
Main Results:
- Angiotensin II receptor blockers (ARBs), cardioselective beta-blockers, and dihydropyridine (DHP) calcium channel blockers (CCBs) were associated with a significantly lower risk of severe AE.
- ARBs and DHP CCBs demonstrated a reduced risk of moderate AE.
- These protective associations were also observed in frequent exacerbators for severe AE.
Conclusions:
- Therapies with ARBs, cardioselective beta-blockers, and DHP CCBs may reduce the risk of acute exacerbations in ACO patients.
- Findings suggest potential benefits of these cardiovascular medications in managing ACO, warranting further clinical consideration.
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.
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