Asthma and Chronic Obstructive Pulmonary Disease as a Comorbidity and Association with the Choice of Antidementia Medication Among Persons with Alzheimer’s Disease

• Published in: Journal of Alzheimer's disease 2020-01, Vol.73 (3), p.1243-1251
• Main Authors: Lampela, Pasi, Tolppanen, Anna-Maija, Koponen, Marjaana, Tanskanen, Antti, Tiihonen, Jari, Hartikainen, Sirpa, Taipale, Heidi
• Format: Article
• Language: English
• Subjects: Acetylcholinesterase; Aged; Aged, 80 and over; Alzheimer Disease - complications; Alzheimer Disease - drug therapy; Alzheimer's disease; Antagonists; Anticholinergics; Asthma; Asthma - complications; Cholinesterase Inhibitors - therapeutic use; Chronic obstructive pulmonary disease; Comorbidity; Confidence intervals; Corticoids; Corticosteroids; Dementia; Drug Prescriptions; Drug therapy; Female; Finland; Health risk assessment; Humans; Initiators; Lung diseases; Male; Memantine; Memantine - therapeutic use; Mortality; Neurodegenerative diseases; Nootropic Agents - therapeutic use; Obstructive lung disease; Pharmacology; Practice Patterns, Physicians; Pulmonary Disease, Chronic Obstructive - complications; Regression models; Retrospective Studies; Statistical analysis
• ISSN: 1387-2877; 1875-8908
• DOI: 10.3233/JAD-190850

Background: Asthma and chronic obstructive pulmonary disease (COPD) are common comorbidities in persons with Alzheimer’s disease (AD). However, pharmacotherapy of these diseases may have opposite mechanisms of action; anticholinergics in asthma/COPD and acetylcholinesterase inhibitors (AChEI) in AD. Objective: To investigate whether existing asthma/COPD affects the choice of AD medication, and the survival of the patients with AD. Methods: In this retrospective cohort study, data from the MEDALZ-study, which includes all community-dwelling persons with AD during 2005–2011 in Finland (n = 70718) was utilized. Persons with asthma/COPD (N = 7211) were defined as having a special reimbursement for asthma/COPD, or long-term use (≥250 days) of inhaled anticholinergics, inhaled corticosteroids, or leukotriene antagonists during the year before AD diagnosis. We compared persons with and without asthma/COPD regarding the choice of the initial antidementia medication (AChEI versus memantine) with logistic regression and mortality with Cox regression model during the follow-up (up to end of 2015). Results: Memantine was favored over AChEIs as first-line treatment to AD in persons with asthma/COPD compared to those without asthma/COPD (odds ratio 1.23, 95% confidence interval (CI) 1.15–1.31). Memantine was also more commonly used among those who used multiple asthma/COPD medications (7.9% of memantine initiators used ≥3 asthma/COPD medications compared with 5.5% of those who initiated with AChEI). Mortality was higher in persons with asthma/COPD compared to those without asthma/COPD (adjusted hazard ratio 1.10, 95% CI 1.07–1.13). Conclusion: More frequent use of memantine instead of AChEI may result from an attempt to prevent possible worsening of asthma/COPD by AChEIs. Vulnerable persons with both AD and asthma/COPD need individually assessed pharmacotherapy for their medical conditions.