Inhaled Corticosteroids and Mortality in COPD: Subjects

We identified all people who had been admitted to the hospital between April 1, 1996, and March 31, 2000, and had been discharged from the hospital with a primary diagnosis of COPD (ie, International Classification of Diseases, ninth revision [ICD-9], codes 490 [not otherwise specified bronchitis], 491 [chronic bronchitis], 492 [emphysema], and 496 [chronic airflow obstruction]). Subjects had to be > 35 years of age on hospital admission as well as permanent residents of the province for at least 1 year prior to hospital admission and 1 year after discharge from the hospital or until death. eye drops for red eye
The outcome variable was death from any cause in the 365 days following discharge from the hospital. We extracted the date and cause of death. The causes of death were derived from death certificates and were divided into the following three groups: COPD and asthma (ICD-9 code 493); cardiovascular (ICD-9 codes 390-459 and 798); and all other causes.
Covariates: At the index hospital admission, we determined the age and sex of subjects, and the number of physician visits for COPD and asthma that had occurred in the year prior to hospital admission. Comorbidity was assessed using the Charlson comorbidity score derived from secondary hospital discharge diagnoses that were listed at the index hospitalization. Dispensing records were obtained for ICSs, P-agonists, ipratropium bromide, theophyllines, antimicrobials, and oral corticosteroids in the year prior to the index hospital admission, as well as between discharge from the hospital and the end of the 1-year observation period or date of death, if this occurred first. Respiratory medication use other than ICSs and the number of physician visits were considered to be markers of disease severity. We excluded from the analysis patients who died within 90 days of hospital discharge to allow the remaining subjects an equal opportunity to receive therapy with ICSs. All were followed up for 1 year or until death. Analyses were performed separately for people 35 to 64 years old and for those > 65 years old. Two study designs were implemented.
In the cohort study, subjects who received at least one prescription for ICSs in the 90 days following hospital discharge were compared to those who did not with respect to the risk of death during the subsequent 275 days. In addition, subjects who did not receive ICSs were divided into those who received bronchodilators and those who did not. The three groups were compared with respect to the risk of death, with the bronchodi-lator group serving as a reference. Finally, analyses were repeated to compare the risk of dying from specific causes.

This entry was posted in Pulmonary Function and tagged , , , .