Cholinesterase inhibitors and the risk of pulmonary disorders in hospitalized dementia patients.

Objective: To evaluate whether Cholinesterase inhibitors (ChEI) are associated with an increased risk of pulmonary disorders (PD) in hospitalized dementia patients.

Methods: We conducted an observational cross-sectional study by examining the medical records of all the dementia patients hospitalized in the acute geriatric ward at the Bertinot Juel Hospital between January 1, 2005 and June 30, 2009. First, we examined whether there were any differences between the patients receiving ChEIs and those who were not. Second, we measured whether the patients had any type of PD outcome, including pneumonia, persistent cough, bronchitis, and asthma. Finally, we studied the association between ChEIs and PD. We used a logistic regression analysis preceded by a univariate analysis to adjust for other variables, such as age, weight, severity of dementia, length of stay in hospital, and history of asthma.

Results: The study included 183 patients with a mean age of 83 years. There were 131 females and 52 males. There were 55 patients with PD, including 37 with pneumonia, 11 with bronchitis, 4 with asthma, 2 with acute respiratory failure and 1 with a persistent cough. In 38 of these cases, the PD was present before hospitalization and was considered the cause of hospitalization. In 17 cases, the PD was not present at admission but occurred during hospitalization. Only ChEI treatment and age (> 80 years) were associated with an increased risk of pulmonary disorders. The adjusted relative risk was 1.98 [1.21, 3.23] for ChEI and 1.30 [1.10, 1.54] for age.

Conclusion: When prescribing ChEIs, physicians should be aware about the risk of PD. As well, withdrawing ChEIs in patients who present repeated PD should be discussed. Prospective studies need to be conducted to confirm our findings.