Abilene, TX—Drugs used to control dementia in patients who also have chronic obstructive pulmonary disease (COPD) appear to raise the risk of exacerbation, according to a new study.

The problem, according to an article in the journal The Consultant Pharmacist, is that cholinesterase inhibitors (ChEIs), commonly used in dementia treatment, increase acetylcholine, a neurotransmitter involved in autonomic regulation of the airways, theoretically resulting in bronchoconstriction and mucous production.

Researchers from Texas Tech University School of Pharmacy sought to determine if ChEI use in patients with COPD puts them at increased risk of exacerbation because of the increased acetylcholine activity.

To determine that, the study team did a retrospective chart review comparing 52 veterans with dementia and COPD who received ChEIs versus 42 not receiving the drugs at the Veterans Affairs (VA) North Texas Health Care System. The results potentially have wide application because the VA treats more than a million patients with COPD, and as many as 15% of the patient population has that diagnosis.

Outcomes were defined as frequency of exacerbation in the first 90 days following ChEI initiation as well as exacerbation severity and a potential protective effect of inhaled anticholinergics.

Results indicate that the risk of exacerbation over 90 days was higher in the ChEI users with 19% experiencing an exacerbation compared with 7% in the nonusers—a clinically significant trend.

Of the patients experiencing an exacerbation, two on ChEIs had multiple exacerbations over the 90 days, the researchers report. At the same time, the use of inhaled anticholinergics was not found to decrease the risk of exacerbation.

“The use of ChEIs may increase the risk of COPD exacerbation in the first 90 days of therapy in patients with dementia and COPD,” study authors write. “This finding is clinically significant as previous studies have indicated no risk.”

In 2012, a larger Canadian study involving more than 7,000 dementia patients found that new users of ChEIs were not at significantly higher risk of visits for emergency care or hospitalizations for COPD or COPD exacerbations than nonusers.

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