title: Cholinesterase inhibitors and adverse pulmonary events in older people with chronic obstructive pulmonary disease and concomitant dementia: a population-based, cohort study.
abstract: BACKGROUND
  Cholinesterase inhibitors (ChEIs) are a mainstay treatment for individuals with dementia. ChEIs may worsen airflow obstruction because of their pro-cholinergic properties.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the risk of serious pulmonary complications in the elderly with concomitant chronic obstructive pulmonary disease (COPD) and dementia who were receiving ChEIs.
  
  
  METHODS
  This was a population-based, cohort study conducted between 2003 and 2010 in residents of Ontario, Canada. Subjects were over the age of 66 years and had concomitant dementia and COPD, identified using linked administrative databases. Exposure to ChEIs was determined using a drug benefits database. The primary outcome was an emergency room (ER) visit or hospitalization for COPD. The risk difference at 60 days and the relative risk (RR) for study outcomes were estimated in the propensity score-matched sample.
  
  
  RESULTS
  Of 266,840 individuals with COPD, 45,503 had a concomitant diagnosis of dementia. A total of 7166 unexposed subjects were matched to subjects newly exposed to ChEIs. New users of ChEIs were not at significantly higher risk of ER visits or hospitalizations for COPD (RR 0.90; 95% CI 0.76, 1.07) or COPD exacerbations (RR 1.02; 95% CI 0.91, 1.15). Furthermore, ER visits for any respiratory diagnoses were not increased among new users of ChEIs (RR 1.02; 95% CI 0.87, 1.19) when compared with non-users. Sub-group analyses were consistent with the main analysis.
  
  
  CONCLUSIONS
  In a large cohort of elderly individuals with COPD and dementia, new users of ChEIs had a similar risk for adverse pulmonary outcomes as those who were not receiving ChEIs.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. stephensona@smh.ca.|St Michael's Hospital, 30 Bond Street, 6th Floor, Toronto, Ontario, Canada, M5B 1W8. stephensona@smh.ca.
authors.forename: Anne
authors.initials: A
authors.lastname: Stephenson
authors.affiliation: Department of Psychiatry, Queen's University, Kingston, ON, Canada.
authors.forename: Dallas P
authors.initials: DP
authors.lastname: Seitz
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: St Michael's Hospital, 30 Bond Street, 6th Floor, Toronto, Ontario, Canada, M5B 1W8.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Longdi
authors.initials: L
authors.lastname: Fu
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Geoff M
authors.initials: GM
authors.lastname: Anderson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
authors.affiliation: St Mary's of the Lake Hospital, Queen's University, Kingston, ON, Canada.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual; D003704:Dementia / Q000150:complications* / Q000188:drug therapy*; D011307:Drug Prescriptions; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D018697:Nootropic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009864:Ontario / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D012123:Pulmonary Ventilation / Q000187:drug effects*; D012140:Respiratory Tract Diseases / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents