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Observational Study
. 2019 Mar 30;6(1):e000407.
doi: 10.1136/bmjresp-2019-000407. eCollection 2019.

COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months

Pradeesh Sivapalan  1 , Truls Sylvan Ingebrigtsen  2 , Daniel Bech Rasmussen  3   4 , Rikke Sørensen  5 , Christian Madelaire Rasmussen  6 , Camilla Bjørn Jensen  7 , Kristine Højgaard Allin  7 , Josefin Eklöf  1 , Niels Seersholm  1 , Joergen Vestbo  8   9 , Jens-Ulrik Stæhr Jensen  1   10
Affiliations
Observational Study

COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months

Pradeesh Sivapalan et al. BMJ Open Respir Res. .

Abstract

Introduction: A large group of patients with chronic obstructive pulmonary disease (COPD) are exposed to an overload of oral corticosteroids (OCS) due to repeated exacerbations. This is associated with potential serious adverse effects. Therefore, we evaluated the impact of a recommended reduction of OCS duration in 2014 on the risk of pneumonia hospitalisation and all-cause mortality in patients with acute exacerbation of COPD (AECOPD).

Methods: This was a nationwide observational cohort study that was based on linked administrative registry data between 1 January 2010 and 31 October 2017. 10 152 outpatients with COPD (median age 70 years) treated with either a short (≤250 mg) or long course (>250 mg) of OCS for AECOPD were included in the study. Cox proportional hazards regression models were used to derive an estimation of multivariable adjusted HRs (aHRs) for pneumonia hospitalisation or all-cause mortality combined and pneumonia hospitalisation and all-cause mortality, separately.

Results: The long course of OCS treatment for AECOPD was associated with an increased 1-year risk of pneumonia hospitalisation or all-cause mortality (aHR 1.3, 95% CI 1.1 to 1.4; p<0.0001), pneumonia hospitalisation (aHR 1.2, 95% CI 1.0 to 1.3; p=0.0110) and all-cause mortality (aHR 1.8, 95% CI 1.5 to 2.2; p<0.0001) as compared with the short course of OCS treatment. These results were confirmed in several sensitivity analyses.

Conclusion: The change of recommendations from long courses to short courses of OCS for AECOPD in 2014 was strongly associated with a decrease in pneumonia admissions and all-cause mortality, in favour of short courses of OCS.

Keywords: clinical epidemiology; copd epidemiology; copd exacerbations; copd pharmacology; pneumonia.

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Conflict of interest statement

Competing interests: JV reports personal fees from GlaxoSmithKline, personal fees from Chiesi Pharmaceuticals, personal fees from Boehringer-Ingelheim, personal fees from Novartis, personal fees from AstraZeneca, outside the submitted work. TSI reports personal fees from AstraZeneca, outside the submitted work.

Figures

Figure 1
Figure 1
Study flowchart. AECOPD, acute exacerbations of chronic obstructive pulmonary disease; DNHSPD, Danish National Health Service Prescription Database; DrCOPD, Danish Register of Chronic Obstructive Pulmonary Disease; OCS, oral corticosteroids.
Figure 2
Figure 2
Cumulative incidence curves for the three outcomes among COPD outpatients treated with long vs short course of OCS, 2010–2017 (P<0.0001).
See this image and copyright information in PMC

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