(147) Trends in severe COPD exacerbations and mortality following the introduction of ultra-long-acting bronchodilators: an interrupted time-series study between 2007 and 2018 in Quebec, Canada

Publication Number: 482

Background: New bronchodilators have been introduced in recent years to treat chronic obstructive pulmonary disease (COPD), including ultra-long-acting beta2-agonists (ultra-LABAs), and fixed-dose combinations of ultra-LABA/long-acting antimuscarinics (LAMA). However, little is known about the trends in severe COPD exacerbations and mortality that followed the introduction of these new bronchodilators at the population level and by various socioeconomic status (SES).

Objectives: To evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across the various SES groups.

Methods: We used an interrupted time-series to compare monthly rates of severe exacerbations and mortality (total and respiratory-related) before and after the introduction of new bronchodilators in the province of Quebec, Canada. Cohorts of individuals aged >65 years with COPD were created from the Quebec Integrated Chronic Disease Surveillance System using a validated algorithm. Monthly severe exacerbations and mortality rates were calculated from hospitalization and death files. We used three segments multivariate autoregressive models to evaluate changes in slopes (i.e., trend effect) after the introduction of ultra-LABAs (03/2013) and after the introduction of ultra-LABA/LAMA (02/2015) compared to the pre-ultra-LABAs period. Major confounding factors and seasonality were accounted for in regression analyses.

Results: At the beginning of each of the three periods, the cohorts included between 64,161 and 79,401 individuals (78±7yo, 50% women). Upward trends in severe exacerbations (+0.55%/month), all-cause (+0.85%/month) and respiratory-related (+0.76%/month) mortality rates were observed from 04/2007 to 02/2013. Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.14%/month; 95%CI -1.90% to -0.38%), which further decreased after 02/2015 (-1.78%/month; 95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%/month; 95%CI -4.38% to -0.47%) and exacerbation (-1,90%/month; 95%CI -3.04% to -0.75%) rates were only observed after 02/2015. Decreases in severe exacerbation and mortality rates were more pronounced in higher SES groups than in lower SES groups.

Conclusions: The arrival of newer bronchodilators was associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD >65 years in the province of Quebec between 2007 and 2018. Public health efforts should focus on closing the gap between lower and higher SES groups.