Reactions 1680, p6 - 2 Dec 2017 Diuretics: adverse respiratory- related morbidity and mortality In elderly patients with COPD, treatment with oral diuretics is associated with increased rates of respiratory-related morbidity and mortality, according to study results reported in the British Journal of Clinical Pharmacology, particularly treatment with loop diuretics. The retrospective cohort study used health administrative data from Ontario, Canada, between 1 April 2008 and 30 April 2013 to identify 99 766 patients ≥66 years of age. Following propensity score adjustment using 55 covariates, the 51 431 new users of diuretics were matched with 48 473 nonusers. Loop diuretics were the most commonly prescribed drug subclass (58.6%), followed by thiazides (38.4%), potassium-sparing diuretics (5.8%) and anhydrase inhibitors (2.0%). Within 30 days of starting treatment, hospitalisation for COPD/pneumonia occurred in 1.9% of diuretic users and 1.5% of nonusers (hazard ratio [HR] 1.22; 95% CI 1.07, 1.40; p=0.003). Diuretic users also had a higher risk of ER visits for COPD/pneumonia (HR 1.35; 1.18, 1.56; p<0.001), COPD/pneumonia mortality (HR 1.41; 1.04, 1.92; p=0.03) and all-cause mortality (HR 1.20; 1.06, 1.35; p=0.003), but no significantly increased risk of ICU admission for COPD/pneumonia, or outpatient respiratory exacerbation. Sensitivity analyses revealed that results were similar in patients with or without a COPD exacerbation in the preceding year, and in patients with or without pre-existing congestive heart failure. Diuretic use was associated with increased respiratory-related morbidity and mortality compared with new use of ACE inhibitors or angiotensin receptor blockers, which the authors note "is noteworthy as both drug groups would be prescribed for similar reasons and recipients of both drug groups would be at increased risk of acute cardiac events, which might masquerade as acute respiratory events". Loop diuretic users had significantly increased rates of hospitalisation for COPD/pneumonia (HR 1.36; 1.16, 1.60; p=0.0002), outpatient respiratory exacerbations (HR 1.11; 1.02, 1.21; p=0.02), ER visits for COPD/ pneumonia (HR 1.62; 1.38, 1.90; p<0.001), ICU admissions for COPD/pneumonia (HR 1.67; 1.08, 2.58; p=0.02) and all-cause mortality (HR 1.31; 1.13, 1.51; p=0.0004). The authors note that "this may be as a result of this drug subclass’ well-known potential to cause metabolic acidosis (which in turn can contribute to hypercapnea) and hyperkalaemia". Apart from thiazide users having a lower risk of outpatient respiratory exacerbations (HR 0.75; 0.66, 0.84; p<0.001), there were no significant associations between other drug classes and any outcomes. The authors note that "while the absolute adverse event rate increases were relatively small, they may be clinically important at the population level". Vozoris NT, et al. Incident diuretic drug use and adverse respiratory events among older adults with COPD. British Journal of Clinical Pharmacology : 15 Nov 2017. Available from: URL: http://doi.org/10.1111/bcp.13465 803284967 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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