TY - JOUR
T1 - Impact of regular inhaled corticosteroid use on chronic obstructive pulmonary disease outcomes
AU - Vollmer, William M.
AU - Peters, Dawn
AU - Crane, Bradley
AU - Kelleher, Christopher
AU - Buist, A. Sonia
N1 - Funding Information:
Financial support: GlaxoSmithKline. Keywords: COPD, Chronic obstructive pulmonary disease, Inhaled corticosteroids, Observational study, Mortality, Health care utilization, Survival analysis. This study was funded by GlaxoSmithKline, which had an advisory role in the design and conduct of the study. However, the basic protocol was developed independently by the investigators. GlaxoSmithKline, and in particular Drs. Joan Soriano and Kourtney Davis, also provided comments on an initial draft of this manuscript. Final decisions about study design, the analysis and interpretation of data, and the wording of this manuscript were made by the study investigators at the Center for Health Research under the direction of Drs. Vollmer and Peters. The authors wish to thank Drs. Cynthia Rand, Gregory Diette, and Jerry Krishnan of Johns Hopkins University for their helpful comments regarding the interpretation of these results. These individuals received no compensation for their role. Finally, we wish to thank Martha Swain for editorial assistance. Correspondence to: William M. Vollmer Center for Health Research 3800 N. Interstate Ave Portland OR 97227-1110 phone: 503-335-6755 fax: 503-335-6311 email: William.vollmer@kpchr.org
PY - 2007/4
Y1 - 2007/4
N2 - Inhaled corticosteroids are often used to manage chronic obstructive pulmonary disease, although the evidence regarding their long-term efficacy in preventing or reducing adverse health outcomes is not definitive. This retrospective cohort study analyzed whether regular inhaled corticosteroid use is associated with reduced health care utilization and all-cause mortality related to chronic obstructive pulmonary disease. Subjects were 2,902 health maintenance organization members aged 50 and over who met criteria for chronic obstructive pulmonary disease. The study used a composite endpoint of time to (1) death or (2) hospitalization or emergency room care related to chronic obstructive pulmonary disease, whichever occurred first, during a 4-year follow-up. Among the 42% of chronic obstructive pulmonary disease patients with an indication of co-morbid asthma, inhaled corticosteroid use was associated with significantly reduced risk for both all-cause mortality and the composite outcome. The reduction in risk was greatest in never- and ex-smokers. Among chronic obstructive pulmonary disease patients with no indication of asthma, inhaled corticosteroid use was associated with reduced risk only in never smokers. These findings generally persisted in separate analyses stratified by asthma status and in sensitivity analyses using four alternative definitions of regular medication use, with comparable results when regular medication use was treated as a fixed covariate defined at the start of follow-up. We conclude that use of inhaled corticosteroids was associated with reduced risk of chronic obstructive pulmonary disease exacerbations and all-cause mortality. This benefit was most pronounced among never-smokers and in those with evidence of co-morbid asthma.
AB - Inhaled corticosteroids are often used to manage chronic obstructive pulmonary disease, although the evidence regarding their long-term efficacy in preventing or reducing adverse health outcomes is not definitive. This retrospective cohort study analyzed whether regular inhaled corticosteroid use is associated with reduced health care utilization and all-cause mortality related to chronic obstructive pulmonary disease. Subjects were 2,902 health maintenance organization members aged 50 and over who met criteria for chronic obstructive pulmonary disease. The study used a composite endpoint of time to (1) death or (2) hospitalization or emergency room care related to chronic obstructive pulmonary disease, whichever occurred first, during a 4-year follow-up. Among the 42% of chronic obstructive pulmonary disease patients with an indication of co-morbid asthma, inhaled corticosteroid use was associated with significantly reduced risk for both all-cause mortality and the composite outcome. The reduction in risk was greatest in never- and ex-smokers. Among chronic obstructive pulmonary disease patients with no indication of asthma, inhaled corticosteroid use was associated with reduced risk only in never smokers. These findings generally persisted in separate analyses stratified by asthma status and in sensitivity analyses using four alternative definitions of regular medication use, with comparable results when regular medication use was treated as a fixed covariate defined at the start of follow-up. We conclude that use of inhaled corticosteroids was associated with reduced risk of chronic obstructive pulmonary disease exacerbations and all-cause mortality. This benefit was most pronounced among never-smokers and in those with evidence of co-morbid asthma.
KW - COPD
KW - Chronic obstructive pulmonary disease
KW - Health care utilization
KW - Inhaled corticosteroids
KW - Mortality
KW - Observational study
KW - Survival analysis
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U2 - 10.1080/15412550701341186
DO - 10.1080/15412550701341186
M3 - Article
C2 - 17530507
AN - SCOPUS:34547402141
SN - 1541-2555
VL - 4
SP - 135
EP - 142
JO - COPD: Journal of Chronic Obstructive Pulmonary Disease
JF - COPD: Journal of Chronic Obstructive Pulmonary Disease
IS - 2
ER -