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      Effect of tiotropium inhaler use on mortality in patients with tuberculous destroyed lung: based on linkage between hospital and nationwide health insurance claims data in South Korea

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          Abstract

          Background

          Although bronchodilator inhaler therapy can improve lung function in patients with tuberculous destroyed lung (TDL), its effect on mortality has not been studied. We evaluated the effect of tiotropium inhaler therapy on mortality in patients with TDL.

          Methods

          A retrospective cohort of 963 patients with TDL was followed for up to ten years by linking hospital and nationwide health insurance claims data. We compared patients receiving tiotropium inhaler with patients without tiotropium after matching with propensity scores. In addition, we elucidated the risk factors of mortality using Cox proportional hazards model.

          Results

          After the propensity score matching, the baseline characteristics were balanced in both the tiotropium group ( n = 105) and the non-tiotropium group (n = 105); including mean age (63.9 vs. 64.4 years, P = 0.715), mean forced expiratory volume in 1 s (FEV 1) (45.0 vs. 45.3%, P = 0.903), and others. After the propensity score matching, the tiotropium group showed better survival than the non-tiotropium group (median survival period: not reached for the tiotropium group vs. 7.24 years for the non-tiotropium group, Prentice-Wilcoxon test, P = 0.008). Multivariate Cox proportional hazard analysis revealed that tiotropium inhaler usage was associated with lower risk of mortality in the multivariate analysis (HR, 0.560; 95% CI, 0.380–0.824; P = 0.003) after adjusting age, sex, BMI, smoking history, mMRC dyspnea score, Charlson Comorbidity Index, concomitant COPD diagnosis, FEV 1, X-ray severity score, and home oxygen usage.

          Conclusions

          Our results suggest that tiotropium inhaler is associated with decreased all-cause mortality in TDL. Further prospective study is required for validation.

          Electronic supplementary material

          The online version of this article (10.1186/s12931-019-1055-5) contains supplementary material, which is available to authorized users.

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          A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003.

          Peter C Austin (2008)
          Propensity-score methods are increasingly being used to reduce the impact of treatment-selection bias in the estimation of treatment effects using observational data. Commonly used propensity-score methods include covariate adjustment using the propensity score, stratification on the propensity score, and propensity-score matching. Empirical and theoretical research has demonstrated that matching on the propensity score eliminates a greater proportion of baseline differences between treated and untreated subjects than does stratification on the propensity score. However, the analysis of propensity-score-matched samples requires statistical methods appropriate for matched-pairs data. We critically evaluated 47 articles that were published between 1996 and 2003 in the medical literature and that employed propensity-score matching. We found that only two of the articles reported the balance of baseline characteristics between treated and untreated subjects in the matched sample and used correct statistical methods to assess the degree of imbalance. Thirteen (28 per cent) of the articles explicitly used statistical methods appropriate for the analysis of matched data when estimating the treatment effect and its statistical significance. Common errors included using the log-rank test to compare Kaplan-Meier survival curves in the matched sample, using Cox regression, logistic regression, chi-squared tests, t-tests, and Wilcoxon rank sum tests in the matched sample, thereby failing to account for the matched nature of the data. We provide guidelines for the analysis and reporting of studies that employ propensity-score matching. Copyright (c) 2007 John Wiley & Sons, Ltd.
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            Mortality in the 4-year trial of tiotropium (UPLIFT) in patients with chronic obstructive pulmonary disease.

            Donald P Tashkin, Steven Kesten, … (2009)
            In the 4-year UPLIFT trial, tiotropium improved lung function and health-related quality of life and decreased exacerbations compared with usual respiratory medications except inhaled anticholinergics in patients with chronic obstructive pulmonary disease (COPD). Mortality and its causes was a secondary endpoint in UPLIFT. We describe the effect of tiotropium on survival and analyze differences between mortality during treatment and during follow-up of discontinued patients. This study involved a randomized, double-blind trial comparing tiotropium with placebo in patients with COPD (>or=40 yr of age; postbronchodilator FEV(1)
            Article 0 comments Cited 74 times – based on 0 reviews     Review now
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              Mortality in COPD: causes, risk factors, and prevention.

              Cristine E Berry, Robert Wise (2010)
              Chronic obstructive pulmonary disease (COPD) is a leading and increasing cause of death, the extent of which is underestimated as a consequence of underdiagnosis and underreporting on death certificates. Data from large trials, such as the Lung Health Study, Towards a Revolution in COPD Health (TORCH), Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT), European Respiratory Society Study on Chronic Obstructive Pulmonary Disease (EUROSCOP), and Inhaled Steroids in Obstructive Lung Disease (ISOLDE), have shown that the causes of death in patients with mild COPD are predominantly cancer and cardiovascular disease, but as COPD severity increases, deaths due to non-malignant respiratory disease are increasingly common. In practice, mortality of patients with COPD can be predicted by a variety of measures including: forced expiratory volume in one second (FEV(1)), the ratio of inspiratory and total lung capacities, exercise capacity, dyspnea scores, and composite indices such as the body-mass index (B), degree of airflow obstruction (O), degree of functional dyspnea (D), and exercise capacity (E) (BODE) index. Smoking cessation improves survival in COPD patients, and in select patients with advanced disease, oxygen therapy, lung volume reduction surgery, or lung transplantation may also improve survival.
              Article 0 comments Cited 68 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ho Cheol Kim: kimhocheol10@gmail.com
                Tae Hoon Kim: rmr21@daum.net
                Ye-Jee Kim: kimyejee@amc.seoul.kr
                Chin Kook Rhee: chinkook77@gmail.com
                Yeon-Mok Oh:
                ORCID: http://orcid.org/0000-0003-0116-4683
                +82-2-3010-3136 , yeonmok.oh@gmail.com
                Journal
                Journal ID (nlm-ta): Respir Res
                Journal ID (iso-abbrev): Respir. Res
                Title: Respiratory Research
                Publisher: BioMed Central (London )
                ISSN (Print): 1465-9921
                ISSN (Electronic): 1465-993X
                Publication date (Electronic): 6 May 2019
                Publication date PMC-release: 6 May 2019
                Publication date (Print): 2019
                Volume: 20
                Electronic Location Identifier: 85
                Affiliations
                [1 ]ISNI 0000 0004 0533 4667, GRID grid.267370.7, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, , University of Ulsan College of Medicine, ; Seoul, South Korea
                [2 ]ISNI 0000 0004 0647 3511, GRID grid.410886.3, Department of Internal Medicine, CHA Bundang Medical Center, , CHA University, ; Seongnam, South Korea
                [3 ]ISNI 0000 0001 0842 2126, GRID grid.413967.e, Department of Clinical Epidemiology and Biostatistics, , Asan Medical Center, ; Seoul, South Korea
                [4 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, , College of Medicine, The Catholic University of Korea, ; Seoul, South Korea
                Author information
                http://orcid.org/0000-0003-0116-4683
                Article
                Publisher ID: 1055
                DOI: 10.1186/s12931-019-1055-5
                PMC ID: 6503445
                PubMed ID: 31060621
                SO-VID: b865689f-4cd2-4721-8a29-82385ec20a39
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 February 2019
                Date accepted : 23 April 2019
                Funding
                Funded by: Ministry of Health and Welfare, Republic of Korea
                Award ID: HC16C-2254-010017
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Respiratory medicine
                Keywords: tuberculosis,tiotropium,propensity score,mortality
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: tuberculosis, tiotropium, propensity score, mortality

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