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Copyright ©ERS Journals Ltd 2003
Inhaled corticosteroids and survival in chronic obstructive pulmonary disease: does the dose matter?
1 Dept of Medicine, Pulmonary Division, University of Alberta, and 2 Institute of Health Economics, Edmonton, Canada
CORRESPONDENCE: D.D. Sin, 2E4.29 Walter C. Mackenzie Centre, University of Alberta, Edmonton, AB T6G 2B7, Canada. Fax: 1 7804076384. E-mail: don.sin@ualberta.ca
Keywords: chronic obstructive pulmonary disease, doses, inhaled corticosteroids, mortality
Received: May 16, 2002
Accepted September 9, 2002
D.D. Sin is supported by a New Investigator Award from the Canadian Institutes of Health Research, Ottawa, Canada, and a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research, Edmonton, Canada.
Recent data suggest that inhaled corticosteroids reduce the number of clinical exacerbations in chronic obstructive pulmonary disease (COPD). It remains unknown whether a dose/response relationship exists. The present study was conducted to evaluate the long-term impact of varying doses of inhaled corticosteroids on COPD mortality.
Hospital discharge data were used to identify all patients aged
Inhaled corticosteroid therapy after discharge was associated with a 25% relative reduction in risk for all-cause mortality (RR 0.75, 95% confidence interval (CI) 0.68–0.82). Patients on medium- or high-dose therapy showed lower risks for mortality than those on low doses (RR 0.77, 95% CI 0.69–0.86 for low dose; RR 0.48, 95% CI 0.37–0.63 for medium dose; and RR 0.55, 95% CI 0.44–0.69 for high dose).
Use of inhaled corticosteroids following hospital discharge for chronic obstructive pulmonary disease was associated with a significant reduction in the overall mortality rate. Low- was inferior to medium- or high-dose therapy in protecting against mortality in chronic obstructive pulmonary disease.
65 yrs recently hospitalised due to COPD in Alberta, Canada (n=6,740). The relative risk (RR) for all-cause mortality was compared across different dose categories of inhaled corticosteroids (none and low, medium and high doses) following hospital discharge.
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