Abstract Background There is growing recognition of the importance of risk factors other than smoking in the development of chronic obstructive pulmonary disease (COPD). However, most clinical trials evaluating inhaler therapy for COPD have primarily involved smoking populations. Consequently, prognostic factors and therapeutic outcomes in COPD patients without a history of smoking remain poorly understood. Hence, this study aimed to investigate the impact of inhaler prescriptions and comorbidities on the prognosis of COPD in never-smokers. Methods A retrospective observational study was conducted using data from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) from January 1, 2002, to December 31, 2019. Survival analyses were performed according to inhaler prescriptions and comorbidities, with follow-up through December 31, 2018. Eligible participants were adults aged ≥40 years with a COPD diagnosis, no history of smoking, and a new inhaler prescription. Patients with a history of cancer during the screening period or who switched inhalers after the index date were excluded. Results Among 2,432 eligible patients, 382 (16.3%) received long-acting muscarinic antagonist(LAMA)/long-acting β2-agonist(LABA) therapy, 1,780 (73.2%) received inhaled corticosteroid (ICS)/LABA, 187 (7.3%) received LAMA monotherapy, and 83 (3.4%) received LABA monotherapy. In multivariate Cox regression analysis, compared with the LAMA/LABA group, the ICS/LABA group (HR 1.65; 95% CI 1.22-2.24) and LAMA group (HR 2.24; 95% CI 1.49-3.38) had significantly higher all-cause mortality. Coexisting heart failure (HR 1.28; 95% CI 1.07-1.54), frequent hospitalizations (≥2 times/year vs. none; HR 1.57; 95% CI 1.21-2.03), lower exercise frequency (≥3 times/week vs. none; HR 0.63; 95% CI 0.52-0.77), along with older age, male sex, and lower body mass index (BMI) were also independently associated with higher all-cause mortality. Conclusion Among never-smokers with COPD, LAMA/LABA therapy was independently associated with better survival compared with LAMA alone or ICS/LABA therapy. Comorbid heart failure, frequent hospitalizations, lower exercise frequency, older age, male sex, and lower BMI were also independently linked to increased all-cause mortality. This abstract is funded by: None
Park et al. (Fri,) studied this question.