Increased mortality in patients with corticosteroid-dependent asthma: a nationwide population-based study

Abstract

IntroductionChronic systemic corticosteroid (CS) therapy is associated with an increased risk of mortality in patients with many chronic diseases. However, it has not been elucidated whether chronic systemic CS therapy is associated with increased mortality in patients with asthma. The aim of this study was to determine the effects of chronic systemic CS therapy on long-term mortality in adult patients with asthma.MethodsA population-based matched cohort study of males and females aged ≥18 years with asthma was performed using the Korean National Health Insurance Service database from 2005 to 2015. Hazard ratio (HR) with 95% confidence interval for all-cause mortality among patients in the CS-dependent cohort (CS use ≥6 months during baseline period) relative to those in the CS-independent cohort (CS use <6 months during baseline period) was evaluated.ResultsThe baseline cohort included 466 941 patients with asthma, of whom 8334 were CS-dependent and 458 607 were CS-independent. After 1:1 matching, 8334 subjects with CS-independent asthma were identified. The HR of mortality associated with CS-dependent asthma relative to CS-independent asthma was 2.17 (95% CI 2.04–2.31). In patients receiving low-dose CS, the HR was 1.84 (95% CI 1.69–2.00); in patients receiving high-dose CS, the HR was 2.56 (95% CI 2.35–2.80).ConclusionsIn this real-world, clinical practice, observational study, chronic use of systemic CS was associated with increased risk of mortality in patients with asthma, with a significant dose–response relationship between systemic CS use and long-term mortality.

Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

“… 5 – 7 Patients with CS-dependent asthma show an increased use of healthcare resources and higher mortality than other patients with asthma. 8 Because it causes a substantial burden on public health, 9 – 11 identifying and modifying factors associated with poor outcomes in patients with CS-dependent asthma may be the cornerstone to improving treatment outcomes in this population.…”

Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma

“… 21 A population-based matched cohort study from Korea revealed that long-term use of SCS was associated with an increased mortality risk in a dose-dependent manner in patients with asthma. 22 Moreover, quantitative studies reported that exacerbation of asthma and long-term OCS-use negatively impacted professional life and made maintaining a normal life challenging. 23 …”

“…However, chronic OCS use has serious side-effects. Moreover, CS-dependent asthma is associated with an increased risk of mortality 22 ; therefore, CS should be considered as the last controller.…”

Oral steroids in asthma: a double-edged sword

“…In this issue of the European Respiratory Journal, LEE et al [4] examine more than 8000 cases of SCS-dependent asthma and report that chronic SCS use is associated with increased risk of mortality (hazard ratio 2.17). They also report that there is a significant dose-response relationship; that is, the higher the dose of steroids, the higher the risk.…”

“…They also report that there is a significant dose-response relationship; that is, the higher the dose of steroids, the higher the risk. LEE et al [4] performed a population-based matched cohort study using the Korean National Health Insurance Service database from 2005 to 2015. The importance of the study comes with the enormous database, a total of 466 941 patients with asthma, of whom 8334 were SCS-dependent.…”