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Respiratory medicine
Research
Examining patterns of multimorbidity, polypharmacy and risk of adverse drug reactions in chronic obstructive pulmonary disease: a cross-sectional UK Biobank study
  1. Peter Hanlon1,
  2. Barbara I Nicholl1,
  3. Bhautesh Dinesh Jani1,
  4. Ross McQueenie1,
  5. Duncan Lee2,
  6. Katie I Gallacher1,
  7. Frances S Mair1
  1. 1 General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Frances S Mair; frances.mair{at}glasgow.ac.uk

Abstract

Objective This study aims: (1) to describe the pattern and extent of multimorbidity and polypharmacy in UK Biobank participants with chronic obstructive pulmonary disease (COPD) and (2) to identify which comorbidities are associated with increased risk of adverse drug reactions (ADRs) resulting from polypharmacy.

Design Cross-sectional.

Setting Community cohort.

Participants UK Biobank participants comparing self-reported COPD (n=8317) with no COPD (n=494 323).

Outcomes Multimorbidity (≥4 conditions) and polypharmacy (≥5 medications) in participants with COPD versus those without. Risk of ADRs (taking ≥3 medications associated with falls, constipation, urinary retention, central nervous system (CNS) depression, bleeding or renal injury) in relation to the presence of COPD and individual comorbidities.

Results Multimorbidity was more common in participants with COPD than those without (17% vs 4%). Polypharmacy was highly prevalent (52% with COPD taking ≥5 medications vs 18% in those without COPD). Adjusting for age, sex and socioeconomic status, those with COPD were significantly more likely than those without to be prescribed ≥3 medications contributing to falls (OR 2.27, 95% CI 2.13 to 2.42), constipation (OR 3.42, 95% CI 3.10 to 3.77), urinary retention (OR 3.38, 95% CI 2.94 to 3.87), CNS depression (OR 3.75, 95% CI 3.31 to 4.25), bleeding (OR 4.61, 95% CI 3.35 to 6.19) and renal injury (OR 2.22, 95% CI 1.86 to 2.62). Concomitant cardiovascular disease was associated with the greatest risk of taking ≥3 medications associated with falls/renal injury. Concomitant mental health conditions were most strongly associated with medications linked with CNS depression/urinary retention/bleeding.

Conclusions Multimorbidity is common in COPD and associated with high levels of polypharmacy. Co-prescription of drugs with various ADRs is common. Future research should examine the effects on healthcare outcomes of co-prescribing multiple drugs with similar potential ADRs. Clinical guidelines should emphasise assessment of multimorbidity and ADR risk.

  • multimorbidity
  • polypharmacy
  • chronic airways disease
  • adverse events

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-018404

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    Footnotes

    • Contributors All authors were involved in the conceptualisation and design of the project and interpretation of results. PH carried out the analysis with support from BDJ, RM and BIN. DL provided statistical support. All authors had access to the data. PH wrote the first draft of the paper and all authors commented on subsequent drafts. All authors approved the final draft for publication. FM is the guarantor.

    • Funding This study was supported by a CSO Catalyst Grant CGA/16/39. BDJ was funded by an NHS Research for Scotland career research fellowship.

    • Competing interests None declared.

    • Ethics approval Participants provided full informed consent to participate in UK Biobank, and this study was covered by the generic ethical approval for UK Biobank studies from the NHS National Research Ethics Service (Ref 16/NW/0274).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement UK Biobank data is available via www.ukbiobank.ac.uk. Syntax for the generation of derived variables and for the analysis used for this study will be submitted to UK Biobank for record.