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Inhaled corticosteroids and the risk of a first exacerbation in COPD patients

¹ Dept of Epidemiology and Biostatistics, McGill University, and ² Division of Clinical Epidemiology, Pharmacoepidemiology Unit, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada

CORRESPONDENCE: S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, R.4.29, Montreal, Canada, H3A 1A1. Fax: 1 5148431493. E-mail: samy.suissa@clinepi.mcgill.ca

Keywords: Chronic obstructive pulmonary disease, cohort studies, drug therapy, inhaled corticosteroids

Received: May 5, 2003
Accepted January 30, 2004

This study was funded by the Canadian Institutes of Health Research (CIHR). The acquisition of the database was funded by Boehringer Ingelheim, GlaxoSmithKline and AstraZeneca. S. Suissa is the recipient of a Distinguished Investigator Award from CIHR. M. Melo is the recipient of a Scholarship from Associação Nacional das Farmácias, Portugal. This study is based on de-identified data provided by the Saskatchewan Department of Health. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Department of Health.

The role of inhaled corticosteroids (ICS) in asthma is well established, but their benefit in the management of chronic obstructive pulmonary disease (COPD) is still controversial. The current study assessed whether ICS are effective in preventing a first exacerbation of COPD.

A cohort of newly treated COPD patients was formed from the Administrative Databases of Saskatchewan Health. The outcome was the occurrence of a first moderate or severe exacerbation from 1990–1999. Moderate exacerbations involved prescriptions for an antibiotic and an oral corticosteroid on the same day. Severe exacerbations were hospitalisations with a primary discharge diagnosis of COPD. A nested case-control design was used and matched on year of birth and cohort entry. Rate ratios (RR) were further adjusted for use of other medication and other confounders.

There were 995 exacerbations among 4,455 subjects. The rate of a first exacerbation was increased with any use of ICS in the year prior to the index date (RR: 1.27; 95% CI: 1.08–1.48) and with current use (RR: 1.51; 95% CI: 1.22–1.87), and it increased with increasing daily doses of ICS.

Inhaled corticosteroids do not seem to be beneficial in reducing the risk of a first exacerbation of chronic obstructive pulmonary disease.

This article has been cited by other articles:

				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]

				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]

				S. Suissa From the authors Eur. Respir. J., October 1, 2004; 24(4): 711 - 711. [Full Text] [PDF]