Polypharmacy and Comorbidity in Patients With Chronic Obstructive Pulmonary Disease

Abstract

PURPOSE: Assess the associated comorbidity of patients with chronic obstructive pulmonary disease (COPD) and analyze the prescribed treatments, polypharmacy criteria and their correlation with other variables. METHODS: Cross-sectional observational study of 123 patients with stable COPD. We recorded demographic, anthropometric and lung function variables and the most relevant comorbidities. We also analyzed and quantified the prescribed treatments. RESULTS: A total of 123 patients were included. Mean age of 73 +/- 9 years, 87% men and 13% women, mean BMI of 28 +/- 4 kg/m2 and mean FEV1% of 57.29 +/- 18% (GOLD I, 13%; II, 51%; III, 31%; IV, 5%). The most common comorbidities were high blood pressure (37%), dyslipidemia (24%), smoking (22%), heart disease (17%), diabetes (12,5%), neurological (11%), prostatic syndrome (13%), vascular disease (10%), neoplasms (9%), hyperuricemia (8.1%), gastrointestinal disease (7.3%), anxiety-depression syndrome (7%), renal failure (3%). The mean Charlson index (CI) was 1.5% +/- 1.1, and the CI adjusted for age was 4.4 +/-1.6. When comparing male and female patients, we found significant differences in terms of age and BMI. With regard to the treatments, 81% of the patients were polymedicated (more than 5 drugs). The average number of drugs prescribed was 8.8 +/- 3.6 (2.2 +/- 0.9 respiratory drugs). The most frequently prescribed drugs were anticholinergic inhalers (81%), inhaled corticosteroids and/or bronchodilators (73%), cardiovascular drugs (45%), antiplatelet-anticoagulant agents (34%), hypolipidemic agents (32%), oxygen therapy (27%), gastroprotective agents (25%), psychotropic agents (16%), prostatic hyperplasia agents (15%), antidiabetic agents (13%) and nervous system agents (11%). We found a significant correlation between the total number of drugs on one hand and age (r=0.22, p<0.02) and FEV1% (r=-0.24, p< 0.06) on the other. We compared the patient groups with and without polypharmacy and found significant differences for the FEV1% variables: 64.30 +/- 17.15% vs. 55.68 +/- 17.95% (p<0.01) and the Charlson index: 0.96 +/- 0.64 vs. 1.65 +/- 1.15 (p<0.006). CONCLUSIONS: 1. The most common comorbidities were HBP, dyslipidemia, smoking and heart diseases. 2. The majority of the patients were polymedicated with an average of 8.8 drugs. We found a correlation between the number of prescribed drugs on one hand and age and lung function on the other.