Inhaled corticosteroids and survival in chronic obstructive pulmonary disease: does the dose matter?

Abstract

Recent data suggest that inhaled corticosteroids reduce the number of clinical exacerbations in chronic obstructive pulmonary disease (COPD). It remains unknown whether a dose/response relationship exists. The present study was conducted to evaluate the long-term impact of varying doses of inhaled corticosteroids on COPD mortality.Hospital discharge data were used to identify all patients aged o65 yrs recently hospitalised due to COPD in Alberta, Canada (n=6,740). The relative risk (RR) for allcause mortality was compared across different dose categories of inhaled corticosteroids (none and low, medium and high doses) following hospital discharge.Inhaled corticosteroid therapy after discharge was associated with a 25% relative reduction in risk for all-cause mortality (RR 0.75, 95% confidence interval (CI) 0.68-0.82). Patients on medium-or high-dose therapy showed lower risks for mortality than those on low doses (RR 0.77, 95% CI 0.69-0.86 for low dose; RR 0.48, 95% CI 0.37-0.63 for medium dose; and RR 0.55, 95% CI 0.44-0.69 for high dose).Use of inhaled corticosteroids following hospital discharge for chronic obstructive pulmonary disease was associated with a significant reduction in the overall mortality rate. Low-was inferior to medium-or high-dose therapy in protecting against mortality in chronic obstructive pulmonary disease.

Efficacy and Safety of Budesonide and Formoterol in One Pressurized Metered-Dose Inhaler in Patients with Moderate to Very Severe Chronic Obstructive Pulmonary Disease

“…reduction of ≥0. The total number of COPD exacerbations requiring Improvements in the SGRQ total scores were hospitalization was very low in all treatment groups significantly greater (p ≤ 0.035) in both budesonide/ (range [11][12][13][14][15][16][17][18][19][20][21][22]; the number of events per patientformoterol groups compared with the budesonide, treatment year was significantly different for formoterol and placebo groups (table V). These budesonide/formoterol 320/9 μg (0.158) compared improvements were clinically meaningful (i.e.…”

“…This result was driven by the exacerbations requiring treatment with oral corticosteroids (79-120 events). The number of exacerbations resulting in hospitalization was very low across treatment groups (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22); the number per patient-treatment year was significantly different for budesonide/formoterol 320/9 μg (0.158) versus other treatment groups (0.081-0.108) except budesonide/formoterol 160/9 μg (0.139), and for budesonide/formoterol 160/9 μg versus formoterol (0.081) [p ≤ 0.05]. All treatments were generally well tolerated.…”

“…[1] pulmonary function. [9][10][11][12][13][14][15][16] The combination of the ICS budesonide and the required to have a history of at least one COPD LABA formoterol administered in a single dry pow-exacerbation treated with a course of oral corticoder inhaler (DPI) [Symbicort ® Turbuhaler ® ; 1 Astra-steroids and/or antibacterials within 1-12 months Zeneca, Lund, Sweden] demonstrated significant before screening (visit 1) and documented use of an improvements in pulmonary function, HR-QOL and inhaled short-acting bronchodilator as rescue medsymptoms, and a significant reduction in exacerba-ication. At screening, spirometry was performed tion rate compared with placebo in patients with before and 15-30 minutes after administration of COPD.…”

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

“…Results of long-term observational studies with respect to exacerbations and mortality are mixed. [48][49][50][51][52][53] The COPE study, a double-blind discontinuation study of fl uticasone (1,000 μg/d), reported that patients who discontinued inhaled corticosteroid therapy had a signifi cantly higher recurrence risk of exacerbations than patients who remained on fl uticasone treatment. 49 We note several limitations in this literature and our work.…”

COPD: Eine entzündliche Erkrankung der Atemwege?

“…Die Exazerbationsrate verminderte sich jedoch im Verhältnis zu Ausmaû der eingeschränkten Lungenfunktion [42]. Retrospektive, epidemiologische Untersuchungen legten eine Verminderung der Mortalität bei Patienten nahe, die wegen einer Exazerbation stationär behandelt wurden [43]. Es wurde jedoch überzeugend belegt, dass diese erwartungsvolle Aussage auf einer fälschlichen Zuordnung der Dauer der inhalativen Steroidtherapie beruhte [44,45].…”