Inhaled corticosteroids in chronic obstructive pulmonary disease: Results from two observational designs free of immortal time bias

Kiri, Victor A.; Pride, N. B.; Soriano, Joan B.; Vestbo, J

doi:10.1016/j.rmedu.2005.09.020

Cited by 32 publications

(42 citation statements)

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“…Nevertheless, both lung cancer and COPD have been previously studied in the GPRD and the findings reported. [13][14][15][16][18][19][20][21] Indeed, the higher risk of lung cancer we found among those with COPD aged 65 or older has also been reported elsewhere. 29 In a large, recent study, Wilson et al, 31 using CT scan together with spirometry to search for emphysema and lung cancer in 3,638 smokers, were intrigued to find absence of a doseresponse relationship between smoking intensity and lung cancer among those with moderate to severe emphysema -a finding which has led to the hypothesis that COPD patients may have some host or susceptibility factors that protect them from developing cancer in general (having taken 30 or more years of exposure to tobacco to develop COPD), whereas in those who are more susceptible to developing cancer, lung cancer is likely to be diagnosed before COPD.…”

Section: Discussionsupporting

confidence: 88%

“…A growing number of studies conducted in the GPRD database have been widely reported elsewhere, and the GPRD update as of December 2006 was used in this study. [18][19][20][21] This study was conducted within a research protocol approved by the Independent Scientific Advisory Committee (ISAC) of the GPRD.…”

Section: Methodsmentioning

confidence: 99%

“…As COPD is a serious condition that needs regular medical management, an individual was considered censored if no GP contact was recorded 12 months after his/her last visit or medical contact -as was done in previous studies using the database. [18][19][20][21] In a similar way, censoring was applied when a patient either left the practice or died.…”

Section: Statisticsmentioning

confidence: 99%

See 2 more Smart Citations

Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database

Kiri

Soriano²,

Visick

et al. 2009

Primary Care Respiratory Journal

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

See 1 more Smart Citation

Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database

Kiri

Soriano²,

Visick

et al. 2009

Primary Care Respiratory Journal

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“…Cohort studies and case-control studies compared the use of ICs with the use of a placebo and found that the former had a beneficial effect on mortality. (60)(61)(62) Those results, however, were not confirmed by prospective clinical trials. (43,63) In a case-control study comparing an IC (fluticasone) with a placebo, Ernst et al noted an increase in mortality from pneumonia.…”

Section: Quality Of Lifementioning

confidence: 82%

Tratamento farmacológico da DPOC

et al. 2011

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ResumoAproximadamente sete milhões de brasileiros acima de 40 anos são acometidos pela DPOC. Nos últimos anos, importantes avanços foram registrados no campo do tratamento medicamentoso dessa condição. Foi realizada uma revisão sistemática incluindo artigos originais sobre tratamento farmacológico da DPOC publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Artigos com tamanho amostral menor de 100 indivíduos foram excluídos. Os desfechos sintomas, função pulmonar, qualidade de vida, exacerbações, mortalidade e efeitos adversos foram pesquisados. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Dos 84 artigos selecionados, 40 (47,6%), 18 (21,4%) e 26 (31,0%) foram classificados com graus A, B e C, respectivamente. Das 420 análises oriundas desses artigos, 236 referiam-se à comparação de fármacos contra placebo nos diversos desfechos estudados. Dessas 236 análises, os fármacos mais frequentemente estudados foram anticolinérgicos de longa duração, a combinação β 2 -agonistas de longa duração + corticosteroides inalatórios e corticosteroides inalatórios isolados em 66, 48 e 42 análises, respectivamente. Nas mesmas análises, os desfechos função pulmonar, efeitos adversos e sintomas geraram 58, 54 e 35 análises, respectivamente. A maioria dos estudos mostrou que os medicamentos aliviaram os sintomas, melhoraram a qualidade de vida, a função pulmonar e preveniram as exacerbações. Poucos estudos contemplaram o desfecho mortalidade, e o papel do tratamento medicamentoso nesse desfecho ainda não está completamente definido. Os fármacos estudados são seguros no manejo da DPOC, com poucos efeitos adversos.Descritores: Doença pulmonar obstrutiva crônica/terapia; Doença pulmonar obstrutiva crônica/mortalidade; Revisão. AbstractApproximately seven million Brazilians over 40 years of age have COPD. In recent years, major advances have been made in the pharmacological treatment of this condition. We performed a systematic review including original articles on pharmacological treatments for COPD. We reviewed articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles with a sample size < 100 individuals were excluded. The outcome measures were symptoms, pulmonary function, quality of life, exacerbations, mortality, and adverse drug effects. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). Of the 84 articles selected, 40 (47.6%), 18 (21.4%), and 26 (31.0%) were classified as grades A, B, and C, respectively. Of the 420 analyses made in these articles, 236 were regarding the comparison between medications and placebos. Among these 236 analyses, the most commonly studied medications (in 66...

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“…Until recently, no large, prospective, controlled trials had shown that use of inhaled or systemic corticosteroids altered the natural history of COPD or affected survival (49,65) (50,(74)(75)(76)(77)(78)(79)(80). The TORCH (Towards a Revolution in COPD Health) trial randomized approximately 6,000 patients with COPD to combined fluticasone/salmeterol, fluticasone alone, salmeterol alone, or placebo and treated them for a 3-year period.…”

Section: Inhaled Corticosteroids Stable Copdmentioning

confidence: 99%

Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease

Falk

Minai²,

Mosenifar³

2008

Proceedings of the American Thoracic Society

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Systemic and local inflammation is central to the pathophysiology of chronic obstructive pulmonary disease (COPD). Increased levels of inflammation have been linked to a more progressive course in COPD and have been shown to be present during an exacerbation. Decreases in inflammatory cytokines, C-reactive protein, and inflammatory cells have been observed with corticosteroid use, suggesting a possible mechanism for a therapeutic benefit of steroids. No available data support the routine use of systemic corticosteroids in stable COPD; however, short courses during exacerbations are likely to improve length of hospitalization, lung function, and relapse rate. Inhaled corticosteroids (ICS) decrease the rate of exacerbation and may improve the response to bronchodilators and decrease dyspnea in stable COPD. No study shows that ICS reduce the loss of lung function; however, recent data suggest a possible survival benefit when combined with long-acting b agonists. There are limited data on the use of ICS in the treatment of acute exacerbations of COPD, and its role in this setting must be more clearly defined. The empiric use of systemic corticosteroids perioperatively represents another area of uncertainty. The role of pharmacogenetics in the metabolism of corticosteroids in COPD is evolving but may be partially responsible for the observed variability in patient responsiveness. The potential benefits of systemic or inhaled corticosteroid use must be weighed against the risk of known toxicities.

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Inhaled corticosteroids in chronic obstructive pulmonary disease: Results from two observational designs free of immortal time bias

Cited by 32 publications

References 0 publications

Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database

Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database

Tratamento farmacológico da DPOC

Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease

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