Inhaled Corticosteroids and Mortality in COPD: Results

Among 1,007 subjects between 35 and 64 years of age, 42 (4.1%) died within the first 90 days and were excluded from the analysis. The remaining 965 subjects were divided into the following two groups: 369 subjects (38.2%) who received ICSs within 90 days of discharge from the hospital; and 596 subjects (61.8%) who did not (Table 1).
The characteristics of subjects who were treated and not treated with ICSs are compared in Table 1, In both age groups, those subjects who received ICSs were more likely to receive other medications within 90 days following hospital discharge. During the year prior to the hospitalization, they visited physicians more frequently for COPD and asthma, and were more likely to be treated with respiratory drugs. Among subjects in the older group, treatment with ICSs was significantly associated with less comorbidity. natural breast enhancement
For subjects between 35 and 64 years of age, the mortality rate between 90 and 365 days was 3.3% in those treated with ICSs and 6% in those not treated with ICSs. The comparable mortality rate for subjects > 65 years of age was 11.7% in those treated with ICSs and 13.1% in those not treated with ICSs (Fig 1). Table 2 shows the effect of ICSs on mortality in the Cox model adjusted for the effect of selected covariates. In subjects > 65 years, ICS use was associated with a 25% reduction in mortality. The use of ipratropium and theophylline as well as age, sex, comorbidity, and the number of prior physician visits were all associated with an increased risk of death. In subjects 35 to 64 years of age, there was an even greater reduction in mortality (53%) in those subjects treated with ICSs.
In the group of subjects > 65 years, we repeated the above analysis after excluding all subjects who had a physician claim for asthma (n = 761) in the year prior to hospitalization. The reduction in mortality associated with ICS use was not affected (adjusted HR, 0.76; 95% CI, 0.61 to 0.95). Further, when all subjects who had received ICSs in the year prior to hospitalization (n = 1,718) were excluded, the reduction in mortality associated with ICS use after hospital discharge was even larger (adjusted HR, 0.66; 95% CI, 0.48 to 0.91).

Table 1—Characteristics of Patients Who Were Hospitalized for COPD by Receipt of ICSs Within 90 Days of Hospital Discharge

Characteristics Patients 35-64 yr Patients a 65 yr
No ICSs (n = 596) ICSs (n = 369) p Value No ICSs(n = 2,393) ICSs (n = 1,629) p Value
At index hospitalization
Age, yr 54.5 ± 8.1 56.3 ± 6.9 < 0.001 77.7 ± 7.1 76.9 ± 6.8 < 0.001
Male sex, % 46 46 0.77 55 54 0.52
Charlson comorbidity score 0.32 ± 0.84 0.29 ± 0.71 0.88 0.53 ± 0.94 0.46 ± 0.93 0.004
One or more medications dispensed within 90 d of hospital discharge, %
Inhaled p-agonists 40 90 < 0.001 48 89 < 0.001
Inhaled ipratropium 30 67 < 0.001 40 74 < 0.001
Oral corticosteroids 28 56 < 0.001 28 49 < 0.001
Oral antimicrobials 48 60 < 0.001 45 53 < 0.001
Oral theophyllines 7 17 < 0.001 9 19 < 0.001
Medication dispensed within 1 yr prior-hospitalization
ICSs,% 20 59 < 0.001 24 71 < 0.001
Inhaled p-agonists, % 43 74 < 0.001 49 79 < 0.001
Inhaled ipratropium, % 23 43 < 0.001 35 59 < 0.001
Oral corticosteroids, % 23 38 < 0.001 23 38 < 0.001
Oral antimicrobials, % 64 75 < 0.001 64 75 < 0.001
Oral theophyllines, % 11 20 < 0.001 11 20 < 0.001
Office visits in the 1 yr prior-hospitalization cq±

t-

5.0 ± 6.2 < 0.001 3.2 ± 5.0 4.8 ± 5.2 < 0.001

Table 2— Risk of Death in the 90-365 Days Following Hospital Discharge

Variables Patients 35-64 yr Patients a 65 yr
Medications used within 90 d of hospital discharge
ICSs 0.47 (0.23-0.98) 0.75 (0.61-0.91)
P-agonists 1.18(0.54-2.57) 1.19(0.93-1.53)
Ipratropium 0.95 (0.46-2.00) 1.26(1.01-1.57)
Theophyllines 1.41 (0.60-3.34) 1.40(1.10-1.79)
Antimicrobials 0.88 (0.49-1.58) 0.94 (0.79-1.13)
Oral corticosteroids 1.20 (0.62-2.32) 1.07 (0.88-1.30)
Age 1.07(1.02-1.12) 1.04(1.03-1.05)
Male gender 0.88 (0.49-1.59) 1.25 (1.04-1.50)
No. of visits in the 1 yr prior to hospitalization 1.02 (0.97-1.07) 1.03(1.02-1.05)
Charlson comorbidity score 1.80(1.56-2.07) 1.36(1.29-1.44)
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