Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease

被引:194
作者
Sin, DD [1 ]
Tu, JV
机构
[1] Univ Alberta, Walter C Mackenzie Ctr 2E4 29, Dept Med, Edmonton, AB T6G 2B7, Canada
[2] Univ Toronto, Sunnybrook & Womens Coll, Hlth Sci Ctr, Inst Clin Evaluat Sci, Toronto, ON, Canada
[3] Univ Toronto, Sunnybrook & Womens Coll, Hlth Sci Ctr, Dept Med, Toronto, ON, Canada
[4] Univ Alberta, Dept Med, Edmonton, AB T6G 2M7, Canada
关键词
chronic obstructive pulmonary disease; inhaled corticosteroids; hospitalization; mortality;
D O I
10.1164/ajrccm.164.4.2009033
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
There is considerable controversy concerning the utility of inhaled corticosteroids for the long-term treatment of patients with COPD. Recent studies have suggested that although inhaled corticosteroids do not alter the rate of decline in lung function, they may reduce airway hyperresponsiveness, decrease the frequency of exacerbations, and slow the rate of decline in the patients' health status. The relationship between inhaled corticosteroids and subsequent risk of hospitalization or mortality remains unknown. We therefore conducted a population-based cohort study using administrative databases in Ontario, Canada (n = 22,620) to determine the association between inhaled corticosteroid therapy and the combined risk of repeat hospitalization and all-cause mortality in elderly patients with COPD. Patients who received inhaled corticosteroid therapy postdischarge (within 90 d) had 24% fewer repeat hospitalizations for COPD (95% confidence interval [CI], 22 to 35%) and were 29% less likely to experience mortality (95% Cl, 22 to 35%) during 1 yr of follow-up after adjustment for various confounding factors. This cohort study has suggested that inhaled corticosteroid therapy is associated with reduced COPD-related morbidity and mortality in elderly patients. Although not definitive, because of the observational nature of these findings, these data provide a compelling rationale for a large randomized trial to determine the effect of inhaled corticosteroids on COPD-related morbidity and mortality.
引用
收藏
页码:580 / 584
页数:5
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