This Article Full Text Full Text (PDF) All Versions of this Article: 200301-019OCv1 168/12/1488    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fan, V. S. Articles by Au, D. H. Search for Related Content PubMed PubMed Citation Articles by Fan, V. S. Articles by Au, D. H.

Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease and Risk of Death and Hospitalization

Time-dependent Analysis

Department of Medicine, University of Washington, and Health Services Research and Development Center of Excellence, Veterans Affairs Puget Sound Health Care System, Seattle, Washington

Correspondence and requests for reprints should be addressed to Vincent S. Fan, M.D., M.P.H., Health Services Research and Development (152), 1660 S. Columbian Way, Seattle, WA 98108-1597. E-mail: vfan{at}u.washington.edu

Observational studies of inhaled corticosteroids in chronic obstructive pulmonary disease (COPD) have shown improved survival whereas randomized trials have not. It has been suggested that this difference may be due to immortal time bias. To investigate this further, we performed a prospective cohort study of patients with COPD, using time-dependent methods to determine whether use of inhaled corticosteroids more than 80% of the time reduced the risk of all-cause mortality and COPD exacerbations. Of 8,033 patients, 2,686 (33%) received inhaled corticosteroids. We did not find a significant reduction in mortality for average inhaled steroid use at either low (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.69–1.33) or medium/high dose (HR, 0.86; 95% CI, 0.67–1.10). Similarly, recent inhaled corticosteroid use was not associated with a reduction in mortality at low (HR, 0.80; 95% CI, 0.60–1.07) or medium/high doses (HR, 0.88; 95% CI, 0.71–1.09). There was no association between inhaled corticosteroid use and hospitalizations or exacerbations due to COPD. Patients using medium/high-dose inhaled corticosteroids did not have a significantly lower risk of COPD hospitalizations (HR, 0.85; 95% CI, 0.64–1.13) or COPD exacerbations (HR, 1.13; 95% CI, 0.94–1.36). In a time-dependent study of outpatients with COPD, adherence to inhaled corticosteroid use was not associated with a decreased risk of mortality or exacerbations.

Key Words: antiinflammatory agents, steroidal/therapeutic use • proportional hazards models • treatment outcome

This article has been cited by other articles:

				J. A. Falk, O. A. Minai, and Z. Mosenifar Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2008; 5(4): 506 - 512. [Abstract] [Full Text] [PDF]

				S. Suissa, R. McGhan, D. Niewoehner, and B. Make Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, October 1, 2007; 4(7): 535 - 542. [Abstract] [Full Text] [PDF]

				P. Kardos, M. Wencker, T. Glaab, and C. Vogelmeier Hospitalizations with Severe COPD Am. J. Respir. Crit. Care Med., June 1, 2007; 175(11): 1207a - 1208. [Full Text] [PDF]

				D. Proud and C.-W. Chow Role of Viral Infections in Asthma and Chronic Obstructive Pulmonary Disease Am. J. Respir. Cell Mol. Biol., November 1, 2006; 35(5): 513 - 518. [Abstract] [Full Text] [PDF]

				C. Macie, K. Wooldrage, J. Manfreda, and N. R. Anthonisen Inhaled Corticosteroids and Mortality in COPD. Chest, September 1, 2006; 130(3): 640 - 646. [Abstract] [Full Text] [PDF]

				D. D. Sin and S. F. P. Man Pharmacotherapy for Mortality Reduction in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, September 1, 2006; 3(7): 624 - 629. [Abstract] [Full Text] [PDF]

				R Stirling Inhaled corticosteroids and mortality in COPD: are we there yet? Thorax, August 1, 2006; 61(8): 735 - 735. [Full Text] [PDF]

				A. O. D'Souza, M. J. Smith, L. A. Miller, and J. Kavookjian An Appraisal of Pharmacoeconomic Evidence of Maintenance Therapy for COPD Chest, June 1, 2006; 129(6): 1693 - 1708. [Abstract] [Full Text] [PDF]

				G. Gartlehner, R. A. Hansen, S. S. Carson, and K. N. Lohr Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes Ann. Fam. Med, May 1, 2006; 4(3): 253 - 262. [Abstract] [Full Text] [PDF]

				S. Imfeld, K. E. Bloch, W. Weder, and E. W. Russi The BODE Index After Lung Volume Reduction Surgery Correlates With Survival. Chest, April 1, 2006; 129(4): 873 - 878. [Abstract] [Full Text] [PDF]

				M. Etminan, S. Gill, M. FitzGerald, and A. Samii Challenges and Opportunities for Pharmacoepidemiology in Drug-Therapy Decision Making J. Clin. Pharmacol., January 1, 2006; 46(1): 6 - 9. [Abstract] [Full Text] [PDF]

				J. M. Samet Inhaled Corticosteroids and Chronic Obstructive Pulmonary Disease: New and Improved Evidence? Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 407 - 408. [Full Text] [PDF]

				V. A. Kiri, N. B. Pride, J. B. Soriano, and J. Vestbo Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Results from Two Observational Designs Free of Immortal Time Bias Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 460 - 464. [Abstract] [Full Text] [PDF]

				C E Brightling, S McKenna, B Hargadon, S Birring, R Green, R Siva, M Berry, D Parker, W Monteiro, I D Pavord, et al. Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease Thorax, March 1, 2005; 60(3): 193 - 198. [Abstract] [Full Text] [PDF]

				J. A. Cramer and M. J. Pugh The Influence of Insulin Use on Glycemic Control: How well do adults follow prescriptions for insulin? Diabetes Care, January 1, 2005; 28(1): 78 - 83. [Abstract] [Full Text] [PDF]

				D. W. Mapel Treatment Implications on Morbidity and Mortality in COPD Chest, August 1, 2004; 126(2_suppl_1): 150S - 158S. [Abstract] [Full Text] [PDF]

				S. Suissa, V. S. Fan, J. R. Curtis, C. L. Bryson, S. D. Fihn, and D. H. Au Inhaled Corticosteroids in COPD and Mortality: Inaccuracies? Am. J. Respir. Crit. Care Med., May 15, 2004; 169(10): 1165 - 1166. [Full Text]

				T. A. Lee and K. B. Weiss Fracture Risk Associated with Inhaled Corticosteroid Use in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 2004; 169(7): 855 - 859. [Abstract] [Full Text] [PDF]

				M. J. Tobin Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 301 - 313. [Full Text] [PDF]