The study, “Mucolytic Agents and Statins Use is Associated with a Lower Risk of Acute Exacerbations in Patients with Bronchiectasis-Chronic Obstructive Pulmonary Disease Overlap,” was published in the Journal of Clinical Medicine.
Bronchiectasis and COPD are two chronic respiratory diseases that can coexist in a patient, a medical condition known as bronchiectasis-COPD overlap, or BCO.
Previous studies have shown that BCO patients are more likely to develop acute exacerbations — episodes in which patients experience a significant aggravation of their symptoms, including increased breathlessness, cough, mucus production, and extreme fatigue — compared to patients with COPD alone.
BCO is still “a neglected area of trials, and it is not covered by guidelines for clinical practice,” the researchers wrote.
In the study, researchers aimed to evaluate the effects of standard medications — statins (medications that reduce lung inflammation), mucolytics (medications that thin mucus), and macrolides (a type of antibiotics) — on acute exacerbations in BCO patients.
The team used data from the National Health Insurance Research Database of Taiwan. Between 2000 and 2009, researchers identified newly diagnosed COPD patients with or without bronchiectasis.
After excluding patients followed for fewer than 28 days, those who were not on COPD medications, and those diagnosed with bronchiectasis but who had never done a chest X-ray or computed tomography (CT) scan, the team focused on 831 BCO patients and 3,321 age-, gender-, and index year-matched COPD patients without bronchiectasis.
At baseline, BCO patients, compared with COPD patients, were followed for shorter periods of time (4.53 vs. 5.22 years), visited the emergency room more frequently (9.63 vs. 3.22%), had more hospitalizations (20.94 vs. 11.38%), and received more prescriptions for COPD medications (36.82 vs. 14.78%).
BCO patients also had a higher rate of stroke (19.98 vs. 15.45%), prior pneumonia (34.78 vs. 9.55%), and malignancy (21.78 vs. 10.87%), compared with patients with COPD only.
During the follow-up period and before the first acute exacerbation, BCO patients received more prescriptions for mucolytics and macrolides, but fewer prescriptions for statins, than COPD patients.
Importantly, researchers found that BCO patients were more susceptible to acute exacerbations, with an adjusted hazard ratio (HR) of 2.26, and had a higher risk of mortality (HR 1.46), compared with patients with COPD alone. HR measures the probability of an event in an experimental group versus the probability of the same event in a control group. In this case, BCO patients are 2.26 times more likely to experience acute exacerbations and 1.46 times more likely to die than COPD patients.
Overall, treatment with statins (HR 0.37), macrolides (HR 0.65), and mucolytics (HR 0.68) was significantly associated with a reduction in the risk of acute pulmonary exacerbations in all patients. Furthermore, statins were associated with a lower risk of mortality (HR 0.32).
In BCO patients in particular, the use of statins and mucolytic agents, but not macrolides, was linked to significantly lower risks of acute pulmonary exacerbations.
“Our study showed that the use of statins and mucolytic agents was associated with a decreased risk of acute exacerbation in the patients with BCO. Further clinical trials are necessary to assess the effects of medications in patients with BCO,” the researchers said.
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