Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

Abstract

BackgroundInhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.Patients and methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1–2 propensity score matching and stabilised inverse probability of treatment weighting.ResultsAmong 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52–0.80) in the propensity score matching and 0.71 (0.56–0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.ConclusionICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

“…Using data from the Clinical Practice Research Datalink (CPRD) in the UK, Oshagbemi et al [ 29 ] did not observe any increase in risk of moderate or severe exacerbations or mortality in a population of + 40,000 COPD patients in primary care irrespective of the blood eosinophil counts. Finally, in a retrospective study on the effect of withdrawal of ICS after hospitalisation for COPD in Japan, Jo et al [ 30 ] observed a reduced incidence of re-hospitalisation for COPD exacerbations or death in patients who withdraw ICS.…”

Corticosteroid use with extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A nationwide observational study

“…We identified the following variables: age; sex; body mass index (BMI) at admission; comorbidities; 18 the Charlson comorbidity index; 19 teaching hospital admission; ICU admission; admission fiscal year; diagnoses; 20 procedures performed on the day of admission; medications used on the day of admission including corticosteroid, and blood product use. BMI (kg/m 2 ) was categorized as <18.5, 18.5–24.9, 25.0–29.9, ≥30.0, or missing data.…”

Current developments and future directions in COPD

“…JO et al [60] investigated whether withdrawal compared to continuation of ICS was related to worse outcomes in terms of rehospitalisation or death or treatment for new exacerbations. Propensity score analyses were used in a retrospective cohort study of patients aged ⩾65 years who were hospitalised for COPD exacerbation using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016 [60]. There was a 30% smaller risk of rehospitalisation or death and significantly less exacerbations in the group that discontinued ICS.…”