Mayank Ajmera

Date of Graduation


Document Type


Degree Type



School of Pharmacy


Pharmaceutical Sciences

Committee Chair

Usha Sambamoorthi

Committee Co-Chair

Nilanjana Dwibedi

Committee Member

Aaron Metzger

Committee Member

George Rust

Committee Member

Cindy Tworek


Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent and progressive airflow limitation caused due to chronic inflammation in the lungs. Approximately 15 million adults in the United States (U.S.) are estimated to be diagnosed with COPD and an equal number may have undiagnosed COPD. Challenges to COPD management include high prevalence of inflammation-related multimorbidity among individuals with COPD. The association between multimorbidity, existing COPD management and role of novel therapies with anti-inflammatory properties (e.g. statins) in improving COPD-specific outcomes is not well researched. Therefore, the purpose of this study was to use real-world observational data to provide a comprehensive understanding of the relationship between multimorbidity and COPD management as well as assess the effectiveness and safety of statins in terms of COPD management. The specific aims of three studies were to: (1) examine the association between inflammation-related multimorbidity and COPD management in terms of COPD medication receipt, long-acting bronchodilators persistence and COPD-specific outcomes; (2) assess the effectiveness of novel statin therapy in improving COPD-specific outcomes; (3) evaluate the safety of statins and other commonly used medications (antidepressants and inhaled corticosteroids) in terms of new-onset diabetes. This study used a retrospective longitudinal dynamic cohort design using data extracted from multiple years (2005-2008) of Medicaid Analytic eXtract (MAX) files to identify Medicaid beneficiaries with newly diagnosed COPD (n = 19,060). Findings from the first study documented very high prevalence of inflammation-related multimorbidity and indicated that it was significantly associated with reduced COPD-medication utilization and decreased persistence on long-bronchodilators. Our study findings suggest that COPD medication management may be poor due to competing demands arising from the presence of inflammation-related multimorbidity. The results from the study on effectiveness of statins revealed that any statin use improved COPD-specific outcomes compared to no statin use. A closer examination of the data revealed that only those with long-term statin use had better outcomes as compared to those with no statin use. We also found that beneficiaries with inflammation-related multimorbidity and statin use had better COPD-specific outcomes compared to those with multimorbidity and no statin use. From the third study, we found that association between statin use and risk of new-onset diabetes was no longer significant in analyses that controlled for selection bias in unobserved characteristics. Collectively, these findings indicate poor COPD management among those with multimorbidity and emphasize the need for novel therapies to effectively manage COPD. In this context, the current study underscores the advantage of statins in improving COPD-specific clinical and economic outcomes. This study indicate the need of randomized clinical trials and long-term observational studies to establish the efficacy, effectiveness, and safety of novel therapeutic agents in management of COPD.