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. 2020 Feb 3;6(1):00246-2019.
doi: 10.1183/23120541.00246-2019. eCollection 2020 Jan.

Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

Taisuke Jo  1   2 , Hideo Yasunaga  3 , Yasuhiro Yamauchi  2 , Akihisa Mitani  2 , Yoshihisa Hiraishi  2 , Wakae Hasegawa  2 , Yukiyo Sakamoto  2 , Hiroki Matsui  3 , Kiyohide Fushimi  4 , Takahide Nagase  2
Affiliations

Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

Taisuke Jo et al. ERJ Open Res. .

Abstract

Background: Inhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.

Patients and methods: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1-2 propensity score matching and stabilised inverse probability of treatment weighting.

Results: Among 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52-0.80) in the propensity score matching and 0.71 (0.56-0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.

Conclusion: ICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

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Conflict of interest statement

Conflict of interest: T. Jo has nothing to disclose. Conflict of interest: H. Yasunaga reports grants from Ministry of Health, Labour, and Welfare, Japan, during the conduct of the study. Conflict of interest: Y. Yamauchi has nothing to disclose. Conflict of interest: A. Mitani has nothing to disclose. Conflict of interest: Y. Hiraishi has nothing to disclose. Conflict of interest: W. Hasegawa has nothing to disclose. Conflict of interest: Y. Sakamoto has nothing to disclose. Conflict of interest: H. Matsui has nothing to disclose. Conflict of interest: K. Fushimi has nothing to disclose. Conflict of interest: T. Nagase has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Schematic diagram of study groupings. a) Study schematic showing each period evaluated in the study. Variables defining patient characteristics and comorbidities were obtained from the hospitalisation for COPD exacerbation, outpatient data, and data from prior hospitalisations. The outcomes were re-hospitalisation or death and incidences of prescriptions at 30 days and 1 year after the hospitalisation. The ICS withdrawal group was identified by discontinuation of the prescription during and after the hospitalisation for COPD exacerbation. b) Flow diagram of the study patients. LABA: long-acting β2-agonist; LAMA: long-acting muscarinic antagonist; ICS: inhaled corticosteroid.
FIGURE 2
FIGURE 2
Cumulative hazard curves for hospitalisation for re-exacerbation or death after hospitalisation for exacerbation in patients with chronic obstructive pulmonary disease (COPD) aged ≥65 years with or without inhaled corticosteroid (ICS) withdrawal. Results for a) 1–2 propensity score-matched population; and b) stabilised inverse probability weighted population.
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