Long-acting beta-agonists reduce mortality of patients with severe and very severe chronic obstructive pulmonary disease: a propensity score matching study.

Nobuyuki Horita,Naoko Kimura,Ryota Kojima,Satoshi Morita,Takeshi Kaneko,Yoshiaki Ishigatsubo,Naoki Miyazawa

doi:10.1186/1465-9921-14-62

Abstract

BackgroundLong-acting beta-agonists were one of the first-choice bronchodilator agents for stable chronic obstructive pulmonary disease. But the impact of long-acting beta-agonists on mortality was not well investigated.MethodsNational Emphysema Treatment Trial provided the data. Severe and very severe stable chronic obstructive pulmonary disease patients who were eligible for volume reduction surgery were recruited at 17 clinical centers in United States during 1988–2002. We used the 6–10 year follow-up data of patients randomized to non-surgery treatment. Hazard ratios for death by long-acting beta-agonists were estimated by three models using Cox proportional hazard analysis and propensity score matching were measured.ResultsThe pre-matching cohort was comprised of 591 patients (50.6% were administered long-acting beta-agonists. Age: 66.6 ± 5.3 year old. Female: 35.4%. Forced expiratory volume in one second (%predicted): 26.7 ± 7.1%. Mortality during follow-up: 70.2%). Hazard ratio using a multivariate Cox model in the pre-matching cohort was 0.77 (P = 0.010). Propensity score matching was conducted (C-statics: 0.62. No parameter differed between cohorts). The propensity-matched cohort was comprised of 492 patients (50.0% were administered long-acting beta-agonists. Age: 66.8 ± 5.1 year old. Female: 34.8%. Forced expiratory volume in one second (%predicted) 26.5 ± 6.8%. Mortality during follow-up: 69.1%). Hazard ratio using a univariate Cox model in the propensity-matched cohort was 0.77 (P = 0.017). Hazard ratio using a multivariate Cox model in the propensity-matched cohort was 0.76 (P = 0.011).ConclusionsLong-acting beta-agonists reduce mortality of severe and very severe chronic obstructive pulmonary disease patients.

Highlights

Long-acting beta-agonists were one of the first-choice bronchodilator agents for stable chronic obstructive pulmonary disease
In this study, we evaluated the life prognosis of patients treated with Long-acting beta-agonists (LABA) in a cohort with prospectively collected data using Cox hazard model and propensity score matching method
Model 1 The stepwise multivariable Cox model analysis which initially included LABA and 26 other covariables as independent variables was performed in the pre-matching cohort

Summary

Introduction

Long-acting beta-agonists were one of the first-choice bronchodilator agents for stable chronic obstructive pulmonary disease. The impact of long-acting beta-agonists on mortality was not well investigated. Long-acting beta-agonists (LABA), one of the first-choice bronchodilator agents for stable chronic obstructive pulmonary disease (COPD) [1] improve obstruction, hyperinflation, quality of life, dyspnea, frequency of exacerbation, and frequency of rescue medication [2,3,4,5,6]. Changes in the quality of life, pulmonary function, and near-death condition from bronchial asthma [7]. In 2007, Calverley et al conducted a large-scale randomized controlled trial spanning 3 years, involving 6112 patients, in which mortality as secondary endpoint was compared between placebo- and LABA-administrated cohorts [3]. Their study showed no significant reduction in mortality, and the authors concluded that the study was not an accurate reflection of the mortality because of high withdrawal rate and fewer observed deaths than anticipated.

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Conclusion