Asthma and Chronic Obstructive Pulmonary Disease as a Comorbidity and Association with the Choice of Antidementia Medication Among Persons with Alzheimer’s Disease
Affiliations: [a] Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| [b] School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| [c] Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, VIC, Australia
| [d] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| [e] Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| [f] Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
Correspondence:
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Correspondence to: Heidi Taipale, PhD (Pharm), University of Eastern Finland, PO Box 1627, Kuopio, 70211
Finland. Tel.: +358 443361265; Fax: +358 17162424; E-mail: [email protected].
Abstract: Background:Asthma and chronic obstructive pulmonary disease (COPD) are common comorbidities in persons with Alzheimer’s disease (AD). However, pharmacotherapy of these diseases may have opposite mechanisms of action; anticholinergics in asthma/COPD and acetylcholinesterase inhibitors (AChEI) in AD. Objective:To investigate whether existing asthma/COPD affects the choice of AD medication, and the survival of the patients with AD. Methods:In this retrospective cohort study, data from the MEDALZ-study, which includes all community-dwelling persons with AD during 2005–2011 in Finland (n = 70718) was utilized. Persons with asthma/COPD (N = 7211) were defined as having a special reimbursement for asthma/COPD, or long-term use (≥250 days) of inhaled anticholinergics, inhaled corticosteroids, or leukotriene antagonists during the year before AD diagnosis. We compared persons with and without asthma/COPD regarding the choice of the initial antidementia medication (AChEI versus memantine) with logistic regression and mortality with Cox regression model during the follow-up (up to end of 2015). Results:Memantine was favored over AChEIs as first-line treatment to AD in persons with asthma/COPD compared to those without asthma/COPD (odds ratio 1.23, 95% confidence interval (CI) 1.15–1.31). Memantine was also more commonly used among those who used multiple asthma/COPD medications (7.9% of memantine initiators used ≥3 asthma/COPD medications compared with 5.5% of those who initiated with AChEI). Mortality was higher in persons with asthma/COPD compared to those without asthma/COPD (adjusted hazard ratio 1.10, 95% CI 1.07–1.13). Conclusion:More frequent use of memantine instead of AChEI may result from an attempt to prevent possible worsening of asthma/COPD by AChEIs. Vulnerable persons with both AD and asthma/COPD need individually assessed pharmacotherapy for their medical conditions.
