Mortality risk in patients receiving drug regimens with theophylline for chronic obstructive pulmonary disease.

摘要: Study Objective. To evaluate outcomes associated with six treatment regimens theophylline versus each regimen without in patients chronic obstructive pulmonary disease (COPD). Design. Retrospective cohort study. Setting. Veterans Affairs health care system. Patients. A total of 183,573 aged 45 years or older who had a diagnosis COPD and were receiving respiratory drug therapy. Measurements Main Results. Patients' identified by using data from October 1, 2002-March 31, 2003, followed for events April 2003-September 30, 2005. Data 2001-September 2002, used to define the patients' baseline characteristics. Primary outcome measures all-cause mortality, exacerbations, COPD-related hospitalizations. Two approaches used: first, assignment was based on therapy at baseline, second, exposure measured as time-varying covariate. Treatment groups stratified propensity receive theophylline. Mortality compared Cox proportional hazards models, other use negative binomial models. Comparisons conducted within individual that same exception Patients treated ipratropium plus (largest group) those alone 1.11-fold increase risk death (95% confidence interval [CI] 1.04-1.18). For regimens, mortality greater than (hazard ratios [HRs] 1.17-1.31). In analysis, (HR 1.23, 95% CI 1.09-1.39) an increased risk. Conclusion. included slightly risks hospitalizations However, benefits factors, including symptoms, quality life, activities daily living, not measured. Clinicians should consider all potential harms when making recommendations.