Incident Diuretic Use May Increase Adverse Events in COPD

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society’s International Conference, taking place in San Diego, California. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2018.

SAN DIEGO — Incident use of diuretic drugs, particularly loop diuretics, was associated with an increased risk for respiratory-related morbidity and mortality for older adults with non-palliative chronic obstructive pulmonary disease (COPD), according to research presented at the annual American Thoracic Society International Conference, held May 18 to23, 2018, in San Diego, California.

Administrative data from 2008 to 2013 on 99,766 adults with COPD in Ontario, Canada, with incident use of an oral diuretic drug were evaluated to determine rates of respiratory-related morbidity and mortality within 30 days.

Individuals with incident use of diuretic drugs showed greater numbers of emergency room visits for pneumonia or COPD (hazard ratio [HR], 1.35; 95% CI, 1.18-1.56; P <.001), significantly increased hospitalization rates for COPD or pneumonia (HR, 1.22; 95% CI, 1.07-1.40; P <.003), and greater pneumonia or COPD-related mortality (HR, 1.41; 95% CI, 1.04-1.92; P <.003) as well as greater all-cause mortality (HR, 1.20; 95% CI, 1.06-1.35; P <.003). These negative outcomes were specifically observed as a result of loop diuretics. The fact that incident diuretic use was also shown to lead to negative respiratory outcomes in healthier subgroups with COPD and in patients taking a new drug with a similar indication (eg, ACE inhibitors, ARBs) strengthens the overall findings.

Although diuretic drugs can improve respiratory health outcomes for COPD by decreasing preload to the heart and decreasing pulmonary edema, diuretic drugs can also induce metabolic alkalosis and hypokalemia, leading to carbon dioxide retention, weakness of respiratory muscles, and respiratory failure. This retrospective, population-based, cohort study sought to contribute to the minimal and conflicting data regarding the effects of diuretic drugs on individuals with COPD by evaluating the association between incident diuretic use by older adults with COPD and respiratory-related morbidity and mortality.

Study investigators concluded, “Our large, population-based cohort study showed the novel finding that incident diuretic drug use (particularly use of loop diuretics) among older adults with non-palliative COPD is associated with increased rates of respiratory-related morbidity and mortality.”

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Reference

Vozoris N, Wang X, Austin P, et al. Incident diuretic drug use and adverse respiratory events among older adults with COPD. Presented at: 2018 American Thoracic Society International Conference; May 18-23, 2018; San Diego, CA. Abstract 3262.