Patients with chronic obstructive pulmonary disease (COPD) who use inhaled corticosteroids may have a significantly decreased mortality risk, according to a new study published in the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP). New research shows that patients who received inhaled corticosteroids within 30 days of hospital discharge had a 25 percent reduced all-cause mortality rate. Cardiovascular-related death alone in patients using steroids paired with beta-agonists was reduced by 38 percent.
"COPD is an undertreated lung disease that has associated heart disease," said author Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada. "Controversy exists with respect to the effect of inhaled corticosteroids on mortality. Our study examined the effect of inhaled corticosteroids on survival, and results suggest that the survival is longer in patients using inhaled corticosteroids."
From April 1995 to March 2000, Dr. Macie and researchers from the University of Manitoba, Winnipeg, Canada, assessed the influence of inhaled corticosteroids on mortality in patients, 90 to 365 days posthospital discharge for COPD. Researchers collected patient information from a comprehensive database, excluding those who died within 90 days. In total, 4,987 patients were split into two groups: those between the ages of 35 to 64 (965) and those 65-years-old or older (4,002). Within those groups, patients who received inhaled corticosteroids within 90 days of hospital discharge were compared with those who did not.
Dr. Macie and colleagues found that the mortality rates in patients 65+ who received inhaled corticosteroids were 11.7 percent, compared with 13.1 percent for those who did not. Patients in the younger group showed even greater results, with a mortality rate of 3.0 percent for patients receiving inhaled corticosteroids within 90 days, compared with 6.0 percent for those who did not, providing a mortality reduction rate of 53 percent. When patients who received steroids in the year prior were removed from the analysis, mortality was reduced by 34 percent. Researchers attribute this finding to multifactorial reasons, including reductions in exacerbations of the disease and suppression of inflammation.
Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.
"Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, " said Dr. Macie. "Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life."
"The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality," said W. Michael Alberts, MD, FCCP, President of the ACCP.
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.
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