Clinical Research Papers:

Effect of the asthma–chronic obstructive pulmonary disease syndrome on the stroke, Parkinson's disease, and dementia: a national cohort study

Jun-Jun Yeh _, Yu-Feng Wei, Cheng-Li Lin and Wu-Huei Hsu

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Oncotarget. 2018; 9:12418-12431. https://doi.org/10.18632/oncotarget.23811

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Jun-Jun Yeh1,2,3,4,*, Yu-Feng Wei5, Cheng-Li Lin6,7 and Wu-Huei Hsu8,9,*

1Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

2Chia Nan University of Pharmacy and Science, Tainan, Taiwan

3Meiho University, Pingtung, Taiwan

4Pingtung Christian Hospital, Pingtung, Taiwan

5Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

6Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

7College of Medicine, China Medical University, Taichung, Taiwan

8Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

*These authors contributed equally to this work

Correspondence to:

Wu-Huei Hsu, email: [email protected]

Jun-Jun Yeh, email: [email protected]

Keywords: asthma–chronic obstructive pulmonary disease syndrome (ACOS); stroke; Parkinson's disease (PD); dementia; inhaler steroids

Received: April 25, 2017     Accepted: November 10, 2017     Published: December 26, 2017


Background: To evaluate the association of asthma–chronic obstructive pulmonary disease syndrome (ACOS) with neurodegenerative diseases (stroke, Parkinson's disease and dementia) and the role of the steroids in the neurodegenerative diseases among the ACOS cohort.

Materials and Methods: Comparison of the ACOS cohort (N = 10,260) with the non-ACOS cohort (n = 20,513) based on the patients aged ≧40 years in the National Health Insurance Research Database from January 1, 2000 to December 31, 2010. These patients follow up to diagnosis of neurodegenerative diseases or the December 31, 2011; using multivariable Cox proportional hazards models.

Results: After adjustment for potential confounders, the [adjusted hazard ratio (aHR), 95% confidence interval (CI)] in the ACOS cohort were [1.39, 1.28–1.50] [1.56, 1.34–1.81] and [1.43, 1.29–1.59] for stroke, Parkinson's disease, dementia; respectively. The [aHR, 95% CI] for ACOS cohort with (inhaler corticosteroids ≧0.13 gram/ oral steroids ≧0.08gram) were with less risk (all aHR<1, p values <0.05) for these 3 neurodegenerative diseases except Parkinson's disease with inhaler corticosteroids >0.43 gram. The risk of stroke and dementia were the lower in patients with < 250 μg/d of a fluticasone equivalent inhaler corticosteroids (aHR = 0.53, 95% CI = 0.35–0.79; aHR = 0.53, 95% CI = 0.31–0.90, respectively).

Conclusions: The ACOS cohort had a higher risk of the neurodegenerative diseases. The lower dose of the inhaler corticosteroids with cumulative dose ≧0.13 gram have the less risk of stroke and dementia.

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