In-Hospital Mortality and Long-term Use of Inhaled Corticosteroids

Abstract

I read with great interest the cross-sectional study data reported by Patil et al 1 about generalizable estimates, admission characteristics, and risk factors for in-hospital mortality in patients admitted for acute exacerbation of chronic obstructive pulmonary disease (COPD). The authors comment that age, sex, median income, comorbid illnesses, nonroutine admissions, and insurance status have a bearing on mortality during hospitalization. The relationship between long-term use of inhaled corticosteroids (ICSs) and systemic corticosteroids on in-hospital mortality was not studied.In a population-based cohort study using administrative databases in Ontario, Canada (n = 22 620), to determine the association between ICS therapy and the combined risk of repeated hospitalization and all-cause mortality in elderly patients with COPD, patients who received ICS therapy after discharge (within 90 days) had 24% fewer repeated hospitalizations for COPD (95% confidence interval , 22%-35%) and were 29% less likely to experience mortality (95% confidence interval, 22%-35%) during 1 year of follow-up after adjustment for various confounding factors. 2 Soto and Varkey 3 conclude that corticosteroids have an impact on the mortality of acute exacerbation of COPD. Soriano et al 4 report that regular use of fluticasone propionate alone or in combination with salmeterol is associated with increased survival of patients with COPD managed in primary care.On the contrary, there are some systematic reviews of randomized placebo-controlled trials showing no benefit of ICSs on mortality but which showed that they do reduce rates of exacerbation. 5 I wonder why the authors did not consider either ICS or systemic corticosteroid use among the admission characteristics or its role in the mortality and other secondary outcomes of the patients. Sujeeth R. Punnam, MD Nacogdoches, Tex 1. Patil SP, Krishnan JA, Lechtzin NL, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med. 2003;163:1180-1186. 2. Sin DD, Tu JV. Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164:580-584. 3. Soto FJ, Varkey B. Evidence based approach to acute exacerbations of COPD. Curr Opin Pulm Med. 2003;9:117-124. 4. Soriano JB, Vestbo J, Pride NB, Kiri V, Maden C, Maier WC. Survival in COPD patients after regular use of fluticasone propionate and salmeterol in general practice. Eur Respir J. 2002;20:819-825. 5. Alsaeedi A, Sin DD, McAlister FA. The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials. Am J Med. 2002;113:59-65. In reply Dr Punnam asks if systemic corticosteroid or ICS use prior to admission for acute exacerbations of COPD influenced inpatient mortality. The objectives of our study 1 were to obtain a generalizable estimate of in-hospital COPD mortality and to identify high-risk groups using readily a...

Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients

“…Punnam et al showed that the hospital mortality of patients increased in parallel with the Deyo Modified Charlson Index score. Instead of the relationship between comorbidity number and mortality, they investigated the relationship between the comorbidity score and mortality (33). The literature has limited data on the relevant issue, and the studies investigating the effect of comorbidities on mortality in COPD generally examine the effects of diseases on mortality.…”