TY - JOUR
T1 - Effect of low climate impact vs. high climate impact inhalers for patients with asthma and COPD-a nationwide cohort analysis
AU - Bonnesen, Barbara
AU - Eklöf, Josefin
AU - Biering-Sørensen, Tor
AU - Modin, Daniel
AU - Miravitlles, Marc
AU - Mathioudakis, Alexander G
AU - Sivapalan, Pradeesh
AU - Jensen, Jens-Ulrik Staehr
N1 - © 2024. The Author(s).
PY - 2024/9/12
Y1 - 2024/9/12
N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD.METHODS: Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression.RESULTS: Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92-1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01-1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers.CONCLUSION: Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD.
AB - BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD.METHODS: Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression.RESULTS: Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92-1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01-1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers.CONCLUSION: Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD.
KW - Humans
KW - Pulmonary Disease, Chronic Obstructive/drug therapy
KW - Male
KW - Female
KW - Middle Aged
KW - Asthma/drug therapy
KW - Aged
KW - Retrospective Studies
KW - Denmark/epidemiology
KW - Cohort Studies
KW - Administration, Inhalation
KW - Adult
KW - Dry Powder Inhalers
KW - Climate
KW - Metered Dose Inhalers
KW - Adrenal Cortex Hormones/administration & dosage
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85203808478&partnerID=8YFLogxK
U2 - 10.1186/s12931-024-02942-8
DO - 10.1186/s12931-024-02942-8
M3 - Journal article
C2 - 39267035
SN - 1465-9921
VL - 25
SP - 339
JO - Respiratory Research
JF - Respiratory Research
IS - 1
M1 - 339
ER -