Impact of regular inhaled corticosteroid use on chronic obstructive pulmonary disease outcomes

William M. Vollmer, Dawn Peters, Bradley Crane, Christopher Kelleher, A (Sonia) Buist

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Volume4
Issue number2
DOIs
StatePublished - Apr 2007

Fingerprint

Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Asthma
Mortality
Patient Acceptance of Health Care
Health Maintenance Organizations
Emergency Medical Services
Risk Reduction Behavior
Disease Progression
Hospital Emergency Service
Hospitalization
Cohort Studies
Retrospective Studies
Health

Keywords

  • Chronic obstructive pulmonary disease
  • COPD
  • Health care utilization
  • Inhaled corticosteroids
  • Mortality
  • Observational study
  • Survival analysis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Impact of regular inhaled corticosteroid use on chronic obstructive pulmonary disease outcomes. / Vollmer, William M.; Peters, Dawn; Crane, Bradley; Kelleher, Christopher; Buist, A (Sonia).

In: COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol. 4, No. 2, 04.2007, p. 135-142.

Research output: Contribution to journalArticle

@article{539ff2b0da184791921f067e1fb6f9ce,
title = "Impact of regular inhaled corticosteroid use on chronic obstructive pulmonary disease outcomes",
abstract = "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.",
keywords = "Chronic obstructive pulmonary disease, COPD, Health care utilization, Inhaled corticosteroids, Mortality, Observational study, Survival analysis",
author = "Vollmer, {William M.} and Dawn Peters and Bradley Crane and Christopher Kelleher and Buist, {A (Sonia)}",
year = "2007",
month = "4",
doi = "10.1080/15412550701341186",
language = "English (US)",
volume = "4",
pages = "135--142",
journal = "COPD: Journal of Chronic Obstructive Pulmonary Disease",
issn = "1541-2555",
publisher = "Informa Healthcare",
number = "2",

}

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)

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 - Chronic obstructive pulmonary disease

KW - COPD

KW - Health care utilization

KW - Inhaled corticosteroids

KW - Mortality

KW - Observational study

KW - Survival analysis

UR - http://www.scopus.com/inward/record.url?scp=34547402141&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547402141&partnerID=8YFLogxK

U2 - 10.1080/15412550701341186

DO - 10.1080/15412550701341186

M3 - Article

C2 - 17530507

AN - SCOPUS:34547402141

VL - 4

SP - 135

EP - 142

JO - COPD: Journal of Chronic Obstructive Pulmonary Disease

JF - COPD: Journal of Chronic Obstructive Pulmonary Disease

SN - 1541-2555

IS - 2

ER -