Abstract
Introduction: Polypharmacy (PP) is frequent in patients with COPD who often have comorbid chronic diseases, and PP increases the risk to experience adverse drug events.
Objective: To determine the prevalence of PP in patients hospitalized for an acute exacerbation of COPD, and the factors associated with PP in this population.
Subjects and methods: ECCO is an observational, prospective, multicentre study. It included those patients admitted with a COPD exacerbation to any of the participating Internal Medicine departments consecutively between January 1, 2007, and December 31, 2008. They were all spirometry-confirmed COPD GOLD II or higher in stable condition. PP was defined as chronic concurrent use of ≥ 5 medications and excessive PP (EPP) as ≥ 10.
Results: 398 patients, 353 men and 45 women, with a mean (SD) age of 73.7 (8.9) years were surveyed. The average use of drugs was 5.0 (2.6). On admission 224 (56.3%) had PP and 22 (5.5%) EPP. Patients with PP had more comorbidity [Charlson index 2.8 (2.8) vs 2.3 (1.6); p=0.004] and more severe mMRC dyspnea (p=0.009) but there were no differences according to GOLD stage. On discharge the average chronic use of drugs was 6.6 (2.4) with an increase in 272 (68.3%) patients. At discharge, 296 patients (78.7%) had PP and 44 (15.9%) EPP. Patients with PP at discharge had more comorbidity and lower FEV1 (p=0.01). In a multivariate logistic regression model PP was associated with lower predicted FEV1, heart failure, hypertension, diabetes, home oxygen therapy and PP on admission.
Conclusion: Polypharmacy is frequently observed in COPD patients, and is associated with more severity of COPD and more comorbidity.
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