Inhaled Corticosteroids and Mortality in COPD

Inhaled Corticosteroids and Mortality in COPDSeveral studies have examined the course of COPD patients to whom inhaled corticosteroids (ICSs) were prescribed. In four studies, ICSs were prescribed within 90 days after discharge from the hospital for a COPD exacerbation, which is a time of relative instability when the risk for hospital readmission or death is high and therapy with ICSs might be expected to be administered to high-risk patients. In such patients > 65 years of age who are treated with ICSs, the risk of death was reduced by 21% over 1 year of follow-up in Ontario’ and 25% over 3 years of follow-up in Alberta. In the United Kingdom, the unadjusted risk of death was reduced by 30% in COPD patients > 50 years of age. On the other hand, there was no reduction in the 1-year mortality rate observed in patients > 55 years of age in Saskatchewan. All-cause mortality over 3 years was also reduced in patients > 50 years of age in the United Kingdom who had received at least three prescriptions of fluticasone over the initial 6-month period. Such a benefit was not found in the US study and the Saskatchewan study using either intent-to-treat or time-dependent analysis. Our objective was to determine the effect of ICSs on total and cause-specific mortality in a cohort of COPD patients using the Province of Manitoba health research database. buy glucophage
The Province of Manitoba provides universal health-care insurance for all its residents (approximately 1.1 million). For research purposes, the Manitoba Population Health Research Repository integrates anonymous records of all inpatient and outpatient physician contacts, vital statistics (for date and cause of death), and drug dispensation records. It is linked via an anonymous identifier to the Population Registry, which provides the duration of health insurance coverage for each permanent Manitoba resident; coverage ends when the resident stops living in the province or dies. Physician contacts are based on fee for service claims describing services provided and the diagnosis for which services are rendered. The Drug Programs Information Network database is created by provincial retail pharmacies entering drug dispensations in real time in order to facilitate screening for inappropriate use, such as drug interactions, and copayment for medication. It captures all dispensing of medications except for drugs given to patients in the hospital. The pharmaceutical database contains anonymous identifiers of drug recipients and information about the drug dispensed (ie, the anatomic therapeutic chemical code; the drug identification number; the date and quantity dispensed; the number of days covered by the supplied medication; and cost).

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