Grant: Travel Awards - Institute Community Support

Chronic obstructive pulmonary disease (COPD) and asthma are both chronic diseases of the airways that make breathing difficult by narrowing the airway. While COPD is common in older people, asthma is viewed as a childhood disease. However, it is not uncommon for older adults to develop asthma. COPD and asthma create a greater risk for older adults because they are more likely to develop respiratory failure as a result of their disease. Treatment of COPD and asthma in older adults is challenging given limited effectiveness and adverse effects of some medications. Inhaled corticosteroids (ICS) are the preferred treatment for long-term control for asthma in young individuals. Most often reported side effects are pneumonia and decreased bone thickness. ICS may be helpful in some COPD patients; however, it remains unclear which group may benefit the most. Given controversy around benefit of ICS for both COPD patients and older adults with asthma, we investigated the effectiveness and safety of ICS in older adults with COPD and/or asthma overtime on a population level in a real-world setting. We took all individuals aged 66 years or older in Ontario, Canada with physician-diagnosed COPD and/or asthma from 2003 to 2014 and followed them until 2015 through provincial health administrative data which includes information on health services provided for all Ontarians. We compared risks of COPD, asthma, or pneumonia hospitalizations overtime between ICS and non-ICS users given similar age, sex and other patient- and disease-related characteristics. We found that in older adults with asthma and/or COPD, only patients with asthma or patients with both asthma and COPD, but not with COPD only, may benefit from ICS which also were safe in these groups. We plan to investigate further which subgroups have the most favourable risk-benefit profiles. This new knowledge can be used by older patients and their physicians to decide whether taking ICS is best for them.