New anticholinergic use may speed up the decline in lung function

New anticholinergic use may speed up the decline in lung function
Around 60% of older adults have at least two chronic conditions, such as hypertension, diabetes, and arthritis. As a result, they often take multiple medications, many of which have anticholinergic properties, which can affect the parasympathetic nervous system by blocking acetylcholine. This can lead to side effects such as dry mouth, constipation, urinary retention, blurred vision, and confusion. Older adults are particularly vulnerable due to reduced kidney and liver function, as well as a weaker blood-brain barrier. While drugs with systemic anticholinergic properties can affect various body parts, including the lungs, studies on their impact on lung function in older adults are limited. Thus, this study aims to examine whether the new use of medications with systemic anticholinergic properties affects lung function in older adults. To explore this, data from the two NEAR studies, the Swedish National study on Aging and Care – Skåne (SNAC-S, also known as the Good Aging in Skåne study, GÅS) and Blekinge (SNAC-B) were used.

Picture: Gordon Johnson, Pixabay

New anticholinergic use may speed up the decline in lung function
In 2936 participants aged 60 years or older who were followed for a mean of 9 years (maximum 19 years), the Anticholinergic Cognitive Burden Scale (ACB) was used to measure the impact of new medications with anticholinergic properties. The annual change in lung function was measured by the forced expiratory volume (FEV1), which is a measure of the amount of air a person can forcefully exhale in one second. During the follow-up, 27.3% of participants started taking at least one medication with anticholinergic properties. Those with a low (ACB score = 1) or high exposure (ACB score ≥2) to anticholinergic use experienced a decrease in their FEV1 of 47.2 and 43.7 ml per year, respectively. In contrast, those not exposed to anticholinergics lost 37.2 ml per year. This suggests that the new use of medications with anticholinergic properties can speed up the decline in lung function, similar to the effects seen in smokers. Further research is needed to understand this potential side effect more comprehensively and explore varying exposure thresholds to anticholinergics and their impact on the lungs.

  
Markus Svensson, first author of the study. Photo: Åsa Hansdotter, Lund University.

Publications
Svensson, M., Elmståhl, S., Sanmartin Berglund, J., Rosso A.  Association of systemic anticholinergic medication use and accelerated decrease in lung function in older adults. Sci Rep. 2024,14, 4362. https://doi.org/10.1038/s41598-024-54879-z