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Abstract #46790 Published in IGR 13-3
Glaucoma management in the patient with airways disease: Are we helping or harming?
Gilbert AL; Roughead EEPharmacoepidemiology and Drug Safety 2010; 19: S98
Background: Glaucoma is common in patients with comorbidity. While effective for glaucoma, nonselective betablockers and pilocarpine are contraindicated where airways disease (AD) is present. Use of latanoprost is cautioned. Objectives: We studied the types of glaucoma medicines dispensed to veterans with AD and their potential for harm. Methods: The Australian Department of Veterans' Affairs claims database was used. All veterans dispensed at least one topical anti-glaucoma medicine in the period Jan to Apr 2008 were included. Subsequent prescriptions of glaucoma medicines were assessed between May to Sep 2008. AD was identified where inhaled respiratory medicines were dispensed. Potential harms associated with use of glaucoma medicines were identified using prescription symmetry and prescription event analyses. Results: Of the 6075 veterans dispensed glaucoma medicines and medicines for AD, 80% were co-dispensed a glaucoma medicine that may aggravate AD: BB 29%, latanoprost 60% and pilocarpine 4%. Prescription symmetry and event analyses showed timolol initiation was associated with increased risk of initiation of inhaled beta-agonist (ASR 1.48; 95% CI 1.28-1.71), inhaled corticosteroid (ASR 1.43, 95% CI 1.19-1.71), oral corticosteroid (ASR 1.14 95% CI 1.01-1.29) and hospitalization for asthma, bronchitis or chronic obstructive pulmonary disease (ASR 1.57, 95% CI 1.07-2.29). Latanoprost initiation was associated with increased initiation of inhaled beta-agonist (ASR 1.24 95% CI1.14-1.35), inhaled corticosteroid (ASR 1.13 95% CI 1.00-1.28), oral corticosteroid (ASR 1.14 95% CI 1.03-1.25), but not hospitalization for airways disease. Pilocarpine initiation was associated with increased use of inhaled beta agonist (ASR 1.33 95% CI 1.05-1.69). Bimatoprost was not associated with increased use of medicines for airways disease. Conclusions: Use of contraindicated medicines for glaucoma in those with AD is high, with symmetry studies suggesting increased harm with timolol, latanoprost and pilocarpine. Care should be taken to determine comorbidities when initiating these medicines.
A.L. Gilbert. Sansom Institute, University of South Australia, Adelaide, Australia.
Classification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
1.1 Epidemiology (Part of: 1 General aspects)
