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

Yoshiaki Ishigatsubo,Nobuyuki Horita,Satoshi Morita,Naoki Miyazawa,Ryota Kojima,Miyo Inoue,Takeshi Kaneko

doi:10.1186/1465-9921-15-37

Yoshiaki Ishigatsubo, Nobuyuki Horita + Show 5 more

Open Access

https://doi.org/10.1186/1465-9921-15-37

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Journal: Respiratory research	Publication Date: Jan 1, 2014
Citations: 40	License type: cc-by

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.

Highlights

Oral corticosteroids were used to control stable chronic obstructive pulmonary disease (COPD) decades ago
In the 1980s, administration of 7.5 − 15 mg/day of longterm oral corticosteroids (LTOC) therapy was proved to improve the prognosis of patients with chronic airflow
Other studies indicated that long-term oral corticosteroids (LTOC) is potentially harmful for stable COPD patients because muscle strength and pulmonary function deteriorate after high dose of systemic corticosteroids [12], and because corticosteroids cause comorbidities such as diabetes, hypertension, and osteoporosis [13]

Summary

Introduction

Oral corticosteroids were used to control stable chronic obstructive pulmonary disease (COPD) decades ago. 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. The impact of LTOC on life prognosis for stable COPD patients has not been clarified. Other studies indicated that LTOC is potentially harmful for stable COPD patients because muscle strength and pulmonary function deteriorate after high dose of systemic corticosteroids [12], and because corticosteroids cause comorbidities such as diabetes, hypertension, and osteoporosis [13]. Many studies do not support the use of LTOC for stable COPD patients, but no study has clearly demonstrated a relationship between LTOC and life prognosis

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