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Published ahead of print on October 2, 2003, doi:10.1164/rccm.200301-019OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1488-1494

A more recent version of this article appeared on December 15, 2003
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Submitted on January 16, 2003
Accepted on October 1, 2003

Inhaled corticosteroids in chronic obstructive pulmonary disease and risk of death

Vincent S Fan1*, Chris L Bryson2, J. Randall Curtis1, Stephan D Fihn3, Pierre-Olivier Bridevaux2, Mary B McDonell2, and David H Au3

1 Medicine, University of Washington, Seattle, WA, USA, 2 Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA, 3 Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA; Medicine, University of Washington, Seattle, WA, USA

* To whom correspondence should be addressed. E-mail: vfan{at}u.washington.edu.

Observational studies of inhaled corticosteroids in COPD have shown improved survival while 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 (HR 0.96, 96% CI 0.69-1.33) or medium/high dose (HR 0.86, 0.67-1.10). Similarly, recent inhaled corticosteroid use was not associated with a reduction in mortality at low (HR 0.80, 0.60-1.07) or medium/high doses (HR 0.88, 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, 0.64-1.13) or COPD exacerbations (HR 1.13, 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: Pulmonary disease, Chronic obstructive, anti-inflammatory agents, steroidal/therapeutic use, Administration




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