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Meta-Analysis
. 2019 Jan-Dec:16:1479973119838280.
doi: 10.1177/1479973119838280.

Mortality and vertebral fracture risk associated with long-term oral steroid use in patients with chronic obstructive pulmonary disease: A systemic review and meta-analysis

Yu-Ping Chang  1 , Chien-Hao Lai  1 , Chiung-Yu Lin  1 , Ya-Chun Chang  1 , Meng-Chih Lin  1 , Inn-Wen Chong  2 , Chau-Chyun Sheu  2 , Yu-Feng Wei  3 , Kuo-An Chu  4 , Jong-Rung Tsai  2 , Cheng-Hung Lee  5 , Yung-Che Chen  1
Affiliations
Meta-Analysis

Mortality and vertebral fracture risk associated with long-term oral steroid use in patients with chronic obstructive pulmonary disease: A systemic review and meta-analysis

Yu-Ping Chang et al. Chron Respir Dis. 2019 Jan-Dec.

Abstract

Short-term oral steroid use may improve lung function and respiratory symptoms in patients with stable chronic obstructive pulmonary disease (COPD). However, long-term oral steroid (LTOS) use is not recommended owing to its potential adverse effects. Our study aimed to investigate whether chronic use of oral steroids for more than 4 months would increase mortality and vertebral fracture risk in patients with stable COPD. A systemic search of the PubMed database was conducted, and meta-analysis was performed using Review Manager 5.3. Five studies with a total of 1795 patients showed there was an increased risk of mortality in patients using LTOS (relative risk, 1.63; 95% confidence interval (CI), 1.19-2.23; p < 0.0001; I2 = 86%). In addition, four studies with a total of 17,764 patients showed there was an increased risk of vertebral fracture in patients using LTOS (odds ratio, 2.31; 95% CI, 1.52-3.50; p = 0.03; I2 = 65%). Our meta-analysis showed LTOS was associated with increased mortality and vertebral fracture risk in patients with COPD, and this risk may be due to the adverse effects of LTOS and progression COPD.

Keywords: COPD; Chronic obstructive pulmonary disease; meta-analysis; mortality; steroid; vertebral fracture.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of included studies.
Figure 2.
Figure 2.
Forest plot showing mortality risk among LTOS users. LTOS: long-term oral steroid; CI: confidence interval; M-H: Mantel-Haenszel.
Figure 3.
Figure 3.
Forest plot showing vertebral fracture risk among LTOS users. LTOS: long-term oral steroid; CI: confidence interval; SE: standard error.
See this image and copyright information in PMC

References

    1. Hsiao AJ, Chen LH, Lu TH. Ten leading causes of death in Taiwan: a comparison of two grouping lists. J Formos Med Assoc 2015; 114: 679–680. - PubMed
    1. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–1544. - PMC - PubMed
    1. Walters JA, Walters EH, Wood-Baker R. Oral corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005; 20: CD005374. - PubMed
    1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017; 195: 557–582. - PubMed
    1. Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 2008; 359: 1543–1554. - PubMed

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