Abstract
BackgroundRecent observational studies suggest that β-blockers may improve long-term prognosis in patients with chronic obstructive pulmonary disease (COPD). We assessed whether β-blocker use improves all-cause mortality in patients with episodes of acute bronchitis.MethodsAn observational cohort study using data from the electronic medical records of 23 general practices in the Netherlands. The data included standardized information about daily patient contacts, diagnoses, and drug prescriptions. Cox regression was applied with time-varying treatment and covariates.ResultsThe study included 4,493 patients aged 45 years and older, with at least one episode of acute bronchitis between 1996 and 2006. The mean (SD) age of the patients was 66.9 (11.7) years, and 41.9% were male. During a mean (SD) follow up period of 7.7 (2.5) years, 20.4% developed COPD. In total, 22.7% had cardiovascular comorbidities, resulting in significant higher mortality rates than those without (51.7% vs. 12.0%, p<0.001). The adjusted hazard ratio of cardioselective β-blocker use for mortality was 0.62 (95% confidence interval [CI], 0.50–0.77), and 1.01 (95% CI 0.75–1.36) for non-selective ones. Some other cardiovascular drugs also reduced the risk of mortality, with adjusted HRs of 0.60 (95% CI 0.46–0.79) for calcium channel blockers, 0.88 (95% CI 0.73–1.06) for ACE inhibitors/angiotensin receptor blockers, and 0.42 (95% CI 0.31–0.57) for statins, respectively.ConclusionCardiovascular comorbidities are common and increase the risk of mortality in adults with episodes of acute bronchitis. Cardioselective β-blockers, but also calcium channel blockers and statins may reduce mortality, possibly as a result of cardiovascular protective properties.
Highlights
Acute bronchitis is a very common pulmonary illness, affecting 44 out of 1,000 adults older than 16 years annually, with 82 percent of episodes occurring in fall or winter.[1]
A prospective study showed that one-third of adults with episodes of acute bronchitis eventually developed asthma or chronic obstructive pulmonary disease (COPD) [3]
All patient contacts with the PLOS ONE | www.plosone.org ß-Blockers in Acute Bronchitis general practitioner are recorded in the electronic medical file using the International Classification of Primary Care (ICPC-2) coding system, and prescriptions are coded according to the Anatomical Therapeutical Chemical Classification (ATC) coding system [19,20]
Summary
Acute bronchitis is a very common pulmonary illness, affecting 44 out of 1,000 adults older than 16 years annually, with 82 percent of episodes occurring in fall or winter.[1]. A prospective study showed that one-third of adults with episodes of acute bronchitis eventually developed asthma or chronic obstructive pulmonary disease (COPD) [3]. Time has come to do so, because multiple recent observational studies suggested that cardiovascular drugs, especially ß-blockers and statins may reduce all-cause mortality in patients with COPD [14,15,16,17,18]. Whether cardiovascular drugs may improve survival in adults with episodes of acute bronchitis has never been studied. Recent observational studies suggest that b-blockers may improve long-term prognosis in patients with chronic obstructive pulmonary disease (COPD). We assessed whether b-blocker use improves all-cause mortality in patients with episodes of acute bronchitis
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