title: Mortality risk in patients receiving drug regimens with theophylline for chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To evaluate outcomes associated with six treatment regimens with theophylline versus each regimen without theophylline in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Veterans Affairs health care system.
  
  
  METHODS
  A total of 183,573 patients aged 45 years or older who had a diagnosis of COPD and were receiving respiratory drug therapy.
  
  
  RESULTS
  Patients' treatment regimens were identified by using data from October 1, 2002-March 31, 2003, and patients were followed for events by using data from April 1, 2003-September 30, 2005. Data from October 1, 2001-September 30, 2002, were used to define the patients' baseline characteristics. Primary outcome measures were all-cause mortality, COPD exacerbations, and COPD-related hospitalizations. Two approaches were used: first, treatment assignment was based on drug therapy at baseline, and second, exposure was measured as a time-varying covariate. Treatment groups were stratified based on propensity to receive theophylline. Mortality was compared by using Cox proportional hazards models, and other outcomes were compared with use of negative binomial models. Comparisons were conducted within individual treatment regimens that were the same with the exception of theophylline. Patients treated with ipratropium plus theophylline (largest group) compared with those treated with ipratropium alone had a 1.11-fold increase in the risk of death (95% confidence interval [CI] 1.04-1.18). For each of the other regimens, the risk of mortality associated with theophylline was greater than that in the regimens without theophylline (hazard ratios [HRs] 1.17-1.31). In the time-varying exposure analysis, theophylline (HR 1.23, 95% CI 1.09-1.39) was associated with an increased mortality risk.
  
  
  CONCLUSIONS
  Patients receiving regimens that included theophylline had slightly increased risks of mortality, COPD exacerbations, and COPD hospitalizations compared with patients receiving the same regimens without theophylline. However, the benefits of theophylline on other factors, including symptoms, quality of life, and activities of daily living, were not measured. Clinicians should consider all of the potential benefits and harms associated with theophylline when making treatment recommendations.
authors.affiliation: Center for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA. todd.lee@va.gov
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.forename: Glen T
authors.initials: GT
authors.lastname: Schumock
authors.forename: Brian
authors.initials: B
authors.lastname: Bartle
authors.forename: A Simon
authors.initials: AS
authors.lastname: Pickard
mesh_terms: D000280:Administration, Inhalation; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D009241:Ipratropium / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013806:Theophylline / Q000009:adverse effects / Q000627:therapeutic use*; D014728:Veterans
chemical_list: D000319:Adrenergic beta-Antagonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D013806:Theophylline; D009241:Ipratropium