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Inhaled corticosteroids and hospitalisation due to exacerbation of COPD

¹ Respiratory Epidemiology Unit, Joint Depts of Epidemiology and Biostatistics, and Occupational Health, McGill University, ² Division of Clinical Epidemiology, Pharmacoepidemiology Unit, Royal Victoria Hospital, Montreal, QC, and ³ Respiratory Division, University Hospital, Saskatoon, SK, Canada

CORRESPONDENCE: P. Ernst, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, QC, Canada H3A 1A1. Fax: 1 5148431493. E-mail: pierre.ernst@clinepi.mcgill.ca

Keywords: chronic obstructive pulmonary disease, inhaled corticosteroids, morbidity

Received: December 9, 2002
Accepted February 24, 2003

This study was supported by a grant from the Fonds de la Recherche en Santé du Québec and by Boehringer Ingelheim, Canada. J. Bourbeau is the recipient of a Senior Clinical Research award from the Fonds de la recherché en santé du Québec and S. Suissa is the recipient of a Distinguished Senior Scientist award from the Canadian Institute of Health Research.

Previous studies have provided conflicting evidence as to the possible benefits of inhaled corticosteroids in the treatment of chronic obstructive pulmonary disease (COPD).

Using the Saskatchewan healthcare databases subjects were identified who were aged 55 yrs, initiating regular treatment for COPD but without any prior treatment for asthma. In the current nested case-control analysis, the authors concentrated on 1,742 subjects with a first hospitalisation for COPD after January 1, 1990 and examined whether the use of inhaled corticosteroids was associated with a change in the risk of a subsequent hospitalisation for COPD.

The cases consisted of 846 patients with a subsequent hospitalisation for COPD. These were matched on age, time since the prior hospitalisation and use of other respiratory therapy to all possible person moments in the cohort without rehospitalisation. After further adjustment for comorbidity, sex, calendar year and intensity of other drug therapy, inhaled corticosteroids were not significantly associated with risk of a subsequent COPD hospitalisation. Even relatively high doses of inhaled corticosteroids, >800 µg of beclomethasone or the equivalent per day, were not associated with the risk of COPD hospitalisation.

No reduction in chronic obstructive pulmonary disease exacerbations requiring hospitalisation, in relation to the use of inhaled corticosteroids, were observed.

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