Background: Little is known about the trends in severe chronic obstructive pulmonary disease (COPD) exacerbations and mortality at the population level that followed the introduction of ultra-long-acting beta2-agonists (ultra-LABA), and fixed-dose combinations of ultra-LABA/long-acting antimuscarinics (LAMA).

Objectives: To evaluate whether the arrival of new bronchodilators was associated with changes in the temporal trends in severe exacerbations and mortality between 2007 and 2018 in the older population with COPD.

Methods: Cohorts of individuals aged >65 years with COPD were created from the Quebec Integrated Chronic Disease Surveillance System. We used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e. trend effect) in monthly severe exacerbation and mortality (total and respiratory-related) rates after the introduction of ultra-LABA (03/2013) and ultra-LABA/LAMA (02/2015) compared to the pre-ultra-LABA period.

Results: Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.12%/month;95%CI -1.89% to -0.36%), which further decreased after 02/2015 (-1.74%/month;95%CI -2.62% to -0.86%). Decreases in respiratory-related mortality (-2.13%/month;95%CI -4.03% to -0.98%) and severe exacerbation (-1,88%/month;95%CI -2.99% to -0.77%) rates were only observed after 02/2015.

Conclusion: The arrival of newer bronchodilators was associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD >65 years in the province of Quebec.