Impact of steroid therapy on exacerbation of chronic obstructive pulmonary disease with community-onset pneumonia: a multicenter retrospective cohort study

Abstract

Introduction: There is no consensus on steroid use in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and pneumonia as a comorbidity. Aims and Objectives: The aim of this study was to evaluate the effectiveness of steroids for patients with COPD exacerbation and pneumonia. Methods: This multicenter retrospective observational study was performed at three acute general hospitals in Japan. We analyzed the association between parenteral or oral steroid therapy and the time to clinical stability in COPD exacerbation complicated by community-onset pneumonia. We included patients with COPD and pneumonia who were admitted to the three hospitals. We excluded patients who had other causes of hypoxia, those who required tracheal intubation or vasopressors on the day of admission, and those who were clinically stable on the day of admission. The primary outcome was the time to clinical stability. We calculated crude subdistribution hazard ratio (sHR) between steroid users and non-steroid users. In addition, we used the Fine–Gray model accounting for the competing risk of death with adjustment for potential confounders. Results: We included 1038 patients (mean age, 80.0 years; 938 [90.4%] male, 595 [57.3%] steroid users). The number of deaths in steroid users and non-steroid users were 41 (6.9%) and 25 (5.6%). The crude and adjusted sHR of the time to clinical stability in steroid users to that in non-steroid users was 3.1 (P = 0.08) and 0.93 (P = 0.40), respectively. Conclusions: Steroid therapy for COPD exacerbation with pneumonia could not significantly improve the time to clinical stability.