Abstract
AimsC-reactive protein (CRP) is an important biomarker in systemic inflammation in COPD; reports have suggested inhaled corticosteroids (ICS) attenuate CRP levels. We evaluated the risk of moderate-to-severe exacerbations, severe exacerbations and all-cause mortality among patients with COPD currently exposed to Inhaled corticosteroids (ICS) stratified by CRP levels compared to never ICS users with low CRP levels. MethodsWe included subjects age 40 or more who had a diagnosis of COPD from January 1, 2005 to January 31, 2014 from the UK Clinical Practice Research Datalink (CPRD). ICS exposure was determined time-dependently, as current, recent, past or never users. We evaluated the risk of moderate-to-severe exacerbations, severe exacerbations and all-cause mortality among ICS users stratified by CRP levels. Results17,722 subjects diagnosed with COPD met the inclusion criteria. Among current or never ICS with elevated CRP levels we found, no significantly reduced risk of moderate-to-severe or severe exacerbations. For patients currently exposed ICS with CRP levels ≥8 mg/L there was no reduced risk of moderate-to-severe exacerbations (adjusted hazard ratio [adj. HR] 0.99; 95% confidence interval [CI] 0.76–1.31) or severe exacerbations (adj.HR 1.52; 95% CI 0.71–3.27). However, we found an increased risk of all-cause mortality among COPD patients with CRP levels ≥8 mg/L irrespective of ICS exposure. ConclusionWe did not find a reduced risk of moderate and/or severe COPD exacerbations among COPD patients with varying CRP levels currently exposed to ICS. However, low-grade systemic inflammation was associated with all-cause mortality among COPD patients.
Highlights
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide [1] and is projected to be the third leading cause of death by the year 2030 [2]
Never or current use of Inhaled corticosteroids (ICS) among COPD patients with C-reactive protein (CRP) levels of ≥20 mg/L was not associated with a significant reduction in the risk of moderate-to-severe or severe COPD exacerbations compared to never ICS users with low CRP serum levels (0–3 mg/L, Tables S1 and S2)
The risk of moderate and/or severe COPD exacerbations or all-cause mortality was comparable between ICS users and nonusers, irrespective of CRP levels
Summary
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide [1] and is projected to be the third leading cause of death by the year 2030 [2]. The ECLIPSE study illustrated that after 3 years of follow-up, all-cause mortality and exacerbation frequency was higher in persistently inflamed COPD patients (as measured by an increase in various biomarkers including CRP) compared to non-inflamed patients [6]. Reports from clinical studies have suggested that ICS attenuate CRP levels among patients with moderate to severe COPD [7,8,9] and elevated CRP levels have been linked with increased risk of severe exacerbations and mortality [10,11]. The Copenhagen City Heart Study followed COPD patients, a small proportion of whom were exposed to ICS over a period of 8 years, and reported that patients with elevated CRP levels in combination with other biomarkers were at increased risk of severe exacerbations [12]. The aim of this study was to evaluate the risk of moderate-tosevere exacerbations, severe exacerbations and all-cause mortality among patients with COPD currently exposed to ICS and never ICS users stratified by CRP categories compared to never ICS users with the lowest CRP categories
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
