title: Thiazolidinediones are associated with a reduced risk of COPD exacerbations.
abstract: BACKGROUND
  Thiazolidinediones (TZDs) are oral antihyperglycemic medications that are selective agonists to peroxisome proliferator-activated receptor gamma and have been shown to have potent anti-inflammatory effects in the lung.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether exposure to TZDs is associated with a decreased risk of chronic obstructive pulmonary disease (COPD) exacerbation.
  
  
  METHODS
  A cohort study was performed by collecting data on all US veterans with diabetes and COPD who were prescribed oral antihyperglycemic medications during from period of October 1, 2005 to September 30, 2007. Patients who had two or more prescriptions for TZDs were compared with patients who had two or more prescriptions for an alternative oral anti-hyperglycemic medication. Multivariable negative binomial regression was performed with adjustment for potential confounding factors. The primary outcome was COPD exacerbations, including both inpatient and outpatient exacerbations.
  
  
  RESULTS
  We identified 7,887 veterans who were exposed to TZD and 42,347 veterans who were exposed to non-TZD oral diabetes medications. COPD exacerbations occurred in 1,258 (16%) of the TZD group and 7,789 (18%) of the non-TZD group. In multivariable negative binomial regression, there was a significant reduction in the expected number of COPD exacerbations among patients who were exposed to TZDs with an incidence rate ratio of 0.86 (95% CI 0.81-0.92).
  
  
  CONCLUSIONS
  Exposure to TZDs was associated with a small but significant reduction in risk for COPD exacerbation among diabetic patients with COPD.
authors: Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA ; Division of Pulmonary and Critical Care, Yale University, New Haven, CT, USA.
authors: Seppo T
authors: ST
authors: Rinne
authors: VA Puget Sound Health Care System, Department of Veterans Affairs, University of Washington, USA ; Department of Health Services, University of Washington, USA.
authors: Chuan-Fen
authors: CF
authors: Liu
authors: VA Puget Sound Health Care System, Department of Veterans Affairs, University of Washington, USA ; Division of Pulmonary and Critical Care, University of Washington, USA.
authors: Laura C
authors: LC
authors: Feemster
authors: VA Puget Sound Health Care System, Department of Veterans Affairs, University of Washington, USA ; Division of Pulmonary and Critical Care, University of Washington, USA.
authors: Bridget F
authors: BF
authors: Collins
authors: VA Puget Sound Health Care System, Department of Veterans Affairs, University of Washington, USA ; Division of General Internal Medicine, University of Washington, USA.
authors: Christopher L
authors: CL
authors: Bryson
authors: Gilead Sciences, Inc., Seattle, WA, USA.
authors: Thomas G
authors: TG
authors: O'Riordan
authors: VA Puget Sound Health Care System, Department of Veterans Affairs, University of Washington, USA ; Department of Health Services, University of Washington, USA.
authors: David H
authors: DH
authors: Au
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065840:Protective Factors; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D045162:Thiazolidinediones / Q000008:administration & dosage*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
chemical_list: D000893:Anti-Inflammatory Agents; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones
keywords: COPD exacerbation; cohort study; glitazones; inflammation; peroxisome proliferator-activated receptors