Evidence suggesting that oral corticosteroids increase mortality in stable chronic obstructive pulmonary disease

Abstract

BackgroundOral corticosteroids were used to control stable chronic obstructive pulmonary disease (COPD) decades ago. However, recent guidelines do not recommend long-term oral corticosteroids (LTOC) use for stable COPD patients, partly because it causes side-effects such as respiratory muscle deterioration and immunosuppression. Nonetheless, the impact of LTOC on life prognosis for stable COPD patients has not been clarified.MethodsWe used the data of patients randomized to non-surgery treatment in the National Emphysema Treatment Trial. Severe and very severe stable COPD patients who were eligible for volume reduction surgery were recruited at 17 clinical centers in the United States and randomized during 1998-2002. Patients were followed-up for at least five years. Hazard ratios for death by LTOC were estimated by three models using Cox proportional hazard analysis and propensity score matching.ResultsThe pre-matching cohort comprised 444 patients (prescription of LTOC: 23.0%. Age: 66.6 ± 5.4 year old. Female: 35.6%. Percent predicted forced expiratory volume in one second: 27.0 ± 7.1%. Mortality during follow-up: 67.1%). Hazard ratio using a multiple-variable Cox model in the pre-matching cohort was 1.54 (P = 0.001). Propensity score matching was conducted with 26 parameters (C-statics: 0.73). The propensity-matched cohort comprised of 65 LTOC(+) cases and 195 LTOC(−) cases (prescription of LTOC: 25.0%. Age: 66.5 ± 5.3 year old. Female: 35.4%. Percent predicted forced expiratory volume in one second: 26.1 ± 6.8%. Mortality during follow-up: 71.3%). No parameters differed between cohorts. The hazard ratio using a single-variable Cox model in the propensity-score-matched cohort was 1.50 (P = 0.013). The hazard ratio using a multiple-variable Cox model in the propensity-score-matched cohort was 1.73 (P = 0.001).ConclusionsLTOC may increase the mortality of stable severe and very severe COPD patients.

Systemic steroids in COPD-the beauty and the beast

“…Based on the cited literature and supported by the findings of Horita et al [ 13 ] there are some simple messages regarding the use of systemic steroids in COPD: a) in moderate or severe acute exacerbations oral steroids should be prescribed in a moderate dose (40 mg prednisolone) for 5 days, b) there is no place for systemic steroids in stable phase COPD, c) in patients treated with systemic steroids outside of an exacerbation steroid treatment should be withdrawn, d) before doing so therapy should be optimized and patients should be re-evaluated to make sure that they do not have an asthma-COPD overlap.…”

“…What does the paper by Horita et al published in this issue of the journal [ 13 ] add to the literature? To my knowledge this is the first analysis that systematically evaluates the effects of systemic steroids on mortality in a considerable sample of COPD patients with severe and very severe COPD.…”

Eosinophilia as a treatable trait in three patients with asthma and COPD

“…Long‐term use of systemic corticosteroids, however, is associated with serious side effects . Importantly, we are not advocating for their indiscriminate regular use in those with frequent exacerbations.…”

<p>Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus?</p>

“…Sustaining these comorbidities may have contributed to the reduced survival. [73][74][75][76] On the other hand, inhaled corticosteroids have been shown to be beneficial in reducing the frequency of COPD exacerbations in those with raised blood eosinophil count, 77 but survival only improved when combination therapy with inhaled long-acting bronchodilators was given. 78 Based on such evidence, clinical guidelines recognize oral corticosteroid therapy as a cornerstone in the management of AECOPD.…”