Treatment of COPD Groups GOLD A and B with Inhaled Corticosteroids in the COSYCONET Cohort – Determinants and Consequences

Abstract

Background In COPD patients of GOLD groups A and B, a high degree of treatment with inhaled corticosteroids (ICS) has been reported, which is regarded as overtreatment according to GOLD recommendations. We investigated which factors predict ICS use and which relationship it has to clinical and functional outcomes, or healthcare costs. Methods We used pooled data from visits 1 and 3 of the COSYCONET cohort (n=2741, n=2053, interval 1.5 years) including patients categorized as GOLD grades 1–4 and GOLD group A or B at both visits (n=1080). Comparisons were performed using ANOVA, and regression analyses using propensity matching and inverse probability weighting to adjust for differences between ICS groups. These were defined as having ICS at both visits (always) vs no ICS at both visits (never). Measures were divided into predictors of ICS treatment and outcomes. Results Among 1080 patients, 608 patients were eligible for ICS groups (n=297 never, n=311 always). Prior to matching, patients with ICS showed significantly (p<0.05 each) impaired lung function, symptoms and exacerbation history. After matching, the outcomes generic quality of life and CO diffusing capacity were increased in ICS patients (p<0.05 each). Moreover, costs for respiratory medication, but not total health care costs, were significantly elevated in the ICS group by 780€ per year. Conclusion ICS therapy in COPD GOLD A/B patients can have small positive and negative effects on clinical outcomes and health care costs, indicating that the clinical evaluation of ICS over-therapy in COPD requires a multi-dimensional approach.

Establishing Quality of Life in Southern Taiwan COPD Patients Using Long-Acting Bronchodilator

“…However, there was a significantly higher SGRQ total score, which indicates a lower quality of life in the triple therapy patients compared with the other treatment groups. In contrast, Lutter et al 26 investigated the relationship of ICS use with clinical and functional outcomes and concluded that ICS treatment led to improvements in generic quality of life, such that there might be a subgroup of patients in groups A and B who experienced l benefits when treated with ICS. The difference in the results may be due to a few reasons.…”

Lower Prevalence of Osteoporosis in Patients with COPD Taking Anti-Inflammatory Compounds for the Treatment of Diabetes: Results from COSYCONET

“…In our study cohort, the prevalence of treatment with ICS and OCS was high as previously described. 17,18 As animal data suggest a particular effectiveness against metformin-induced corticosteroid induced osteoporosis, 13 it might be speculated that the beneficial effect observed by us was linked to the high level of corticosteroid treatment. We did not test whether in the GOLD group D the beneficial effect was also present in patients without corticosteroids, as the number of these patients was too small and they probably represented a highly biased sub-population.…”

“…Conversely, anti-inflammatory medication with systemic action, in particular anti-diabetic medication containing metformin, sulfonylureas, glinides or DPP4I, 11,14,15 could have the potential to reduce the risk of osteoporosis. 13,16 A further contributing factor in COPD may be the fact that many patients are treated with inhaled corticosteroids (ICS), 17 with a significant proportion receiving oral corticosteroids (OCS). 18 OCS use clearly promotes the development and progression of osteoporosis, 19 whereas findings for ICS use are equivocal in patients with COPD -although there is an increased risk of osteoporosis in patients with asthma, especially when receiving high-dose ICS.…”

“…A further contributing factor in COPD may be the fact that many patients are treated with inhaled corticosteroids (ICS), 17 with a significant proportion receiving oral corticosteroids (OCS). 18 OCS use clearly promotes the development and progression of osteoporosis, 19 whereas findings for ICS use are equivocal in patients with COPD – although there is an increased risk of osteoporosis in patients with asthma, especially when receiving high-dose ICS.…”

Journal Club: Biologics and Potential for Immune Modulation in Chronic Obstructive Lung Disease

“…22 While a lot has been learned in the past few decades about the inflammatory and immune pathways implicated in acute COPD exacerbations and disease progression, the primary anti-inflammatory medications in use have remained oral corticosteroids for treatment of acute exacerbations and inhaled corticosteroids for maintenance therapy in patients that are frequent exacerbators. [23][24][25][26][27][28] The potential side effects of long-term oral corticosteroids are well known, and corticosteroids are not particularly effective in suppressing neutrophilic inflammation. Other anti-inflammatory agents used for COPD have included phosphodiesterase inhibitors 7,[29][30][31] and macrolide antibiotics, both of which have been shown to reduce neutrophilic inflammation and reduce exacerbation frequency.…”