Clinical characteristics and outcomes of polypharmacy in COPD patients: A cross-sectional study from Crete-Greece

Aim: Polypharmacy and multimorbidity in Chronic Obstructive Pulmonary Disease (COPD) are highly prevalent, with potential associations with worse COPD outcomes. The aim of this study was to identify clinical characteristics of polypharmacy, investigate its relation with health status and exacerbations and assess the prevalence of inappropriate medication (PIMs), risk of adverse drug reactions (ADRs) and drug-drug interactions in COPD patients.Method: A total of 245 COPD patients were enrolled from different primary care settings in Crete-Greece. Patients completed a structured data collection questionnaire and the COPD Assessment Test (CAT). Multimorbidity was defined as having ≥2 comorbidities and polypharmacy was defined as taking ≥5 drugs per day.Results: Most of COPD patients (77.05%) and the majority (83.65%) of elderly (≥65 years), had multimorbidity, while polypharmacy was evident in 55.23% of all patients, and 62.42% in elderly. After adjustments for confounders, polypharmacy was associated with CAT≥10, multimorbidity, coronary heart disease, hyperuricemia and depression-anxiety disorder. PIMs were found in 9.6% of subjects aged ≥65 years and were mainly drugs used for treating mental health. Due to coadministration of medications with similar ADRs, 22.3% of the population were at cumulative risk for falls, 17% for constipation and 12.8% for cardiovascular events. Finally, 15 pairs of drug-to-drug interactions were identified in 11.5% of patients. Conclusion: Our data suggest that polypharmacy is highly prevalent and associated with worse health status and prescription risks in COPD patients. These findings potentially introduce an additional challenge on effective management of these patients.Key words: polypharmacy, multimorbidity, Chronic Obstructive Pulmonary Disease, potentially inappropriate medication (PIMs), drug-to-drug interactions, adverse drug reactions (ADRs)  Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Conflict of Interest: The authors declare that they have no conflict of interest. Dr.Tsiligianni reports grants from GSK Hellas during the conduct of the study; personal fees from Novartis, Menarini, GSK, Boehringer Ingelheim, Astra Zeneca, grants from ELPEN, and GSK Hellas outside the submitted work.Funding: Glaxo Smith Kline HellasEthics approval: Ethical approval was provided by the University of Crete Ethics Committee (protocol number 28/6.11.2018). The authors confirm that the study was conducted in accordance with the Declaration of Helsinki (1964).Informed consent: Informed consent was obtained from all individual participants included in the study. References and Clinical Trial Registry Information