Patients with chronic COPD undergoing elective surgery have lower survival and increased costs in the year following surgery when compared with peers without COPD, according to a study published in CMAJ, the Canadian Medical Association Journal. Ashwin Sankar, MD, and colleagues conducted a retrospective population-based cohort study involving patients undergoing elective surgery during 2005-2019. COPD status was ascertained using validated definitions. Survival and costs to the health system were evaluated in the year after surgery. Data were included for 932,616 patients, 18% of whom had COPD. COPD had a partially adjusted HR of 1.61 and a fully adjusted HR of .26 with respect to the association with risk for death. COPD was associated with a partially adjusted relative increase of 13.1% and a fully adjusted increase of 4.6% with respect to the impact on health system costs. The association between COPD and outcomes was modified by
frailty, cancer, and procedure type. “Peri-operative patient care should include comprehensive assessment and treatment tailored not only to COPD, but also to management of concomitant conditions and surgical disease,” the study authors wrote.
Combination Drug Approved for Asthma
With the FDA approval of combination albuterol and budesonide inhalation aerosol (Airsupra, Astra Zeneca), adults with asthma have a new rescue medication option. The agent was approved for “the as-needed treatment or prevention of bronchoconstriction and to reduce the risk of asthma attacks in patients with asthma 18 years of age and older.” It is the first FDA-approved combination of an inhaled corticosteroid and a short-acting beta agonist. The drug is meant to be administered on an as-needed basis as two oral inhalations, combining albuterol 90 mcg and budesonide 80 mcg per inhalation. Approval is based on results of a randomized, double-blind, controlled study in which adults with moderate-to-severe asthma were randomized to the combination or albuterol alone for at least 24 weeks. Compared with those in the abulterolalone arm, those in the combination arm experienced a 28% reduction in risk for severe asthma attack.