Statin use in COPD patients and risk of exacerbations: a cohort study using data from English primary care

Statin use and exacerbations in COPD

Chronic obstructive pulmonary disease (COPD) is a respiratory condition in which there is a long-term decline in lung function. Symptoms are cough and breathlessness and flare-ups called exacerbations, and characterised by increased inflammation, can occur. An exacerbation may result in hospital admission and may have long-lasting effects on the patient. There are limited therapies for preventing exacerbations.

Many COPD patients already take statins for prevention of cardiovascular disease. As well as lowering cholesterol, statins have anti-inflammatory effects which means that they might have beneficial effects on diseases additional to cardiovascular disease. Some study results suggest that statins reduce the frequency and severity of COPD exacerbations. However a trial of statin therapy for COPD was stopped due to lack of benefit. These conflicting results may be because the trial used a very strictly defined subgroup of patients with moderate-severe COPD and no pre-existing cardiovascular disease. Also, non-trial studies may have produced biased results due to the way in which statin usage was defined.

Our proposed study will use data on COPD patients extracted from a large primary care database. We will define statin use carefully so as not to introduce biases. We will investigate the effects of statins on subsequent exacerbation frequency. We will use a very broad definition of COPD to define our population. We will investigate the effects of statin use overall and within subgroups with different severity of COPD, with pre-existing cardiovascular disease, and with evidence of inflammation.

If our results suggest that statin use has beneficial effects in COPD, they can be used to justify and plan new trials of statin use in COPD, which has the potential to dramatically change the future management of these patients and help reduce the significant morbidity, mortality and health service costs of exacerbations.