Abstract
Purpose: Although the benefits of adding inhaled corticosteroid (ICS) to long-acting bronchodilators (LB) are still unclear, frequent exacerbators (FEs) are suggested to add ICS to their LB treatment. The objective of this study is to analyze whether adding ICS to LB therapy reduces mortality and to perform an in-depth analysis on FEs.
Methods: We enrolled patients discharged from hospital with COPD diagnosis between 2006-2009 in the Lazio region, Italy. FEs were defined as continuous users of both oral corticosteroids and antibacterials. The first prescription for LB or ICS following discharge was defined as the index prescription. Only new users were included. A 4-day time-window was used to classify patients into “LB alone” or “LB plus ICS” initiators. We used propensity score to balance the study groups. Adjusted hazard ratios (HR) were estimated by Cox regression.
Results: Among the 18618 adults enrolled, 12210 initiated “LB plus ICS” therapy and 6408 “LB alone”. Crude mortality rates were 110 and 143 cases per 1000 person-years in the “LB plus ICS” and “LB alone” groups, respectively. The HR was 0.84 (95%CI: 0.72-0.98; p-value: 0.027). A total of 2256 FEs were analyzed; 1505 initiated “LB plus ICS” whereas 751 “LB only”. When analyzing FEs, the benefit of the combination therapy was more pronounced, HR=0.63 (95% CI: 0.44-0.90; p-value: 0.012).
Discussion: Our findings showed a beneficial effect on mortality of adding ICS to LB. The advantage was much more pronounced in FEs.The higher effect of the combined treatment in FEs suggests a crucial role of inflammatory mechanisms and the potential benefit of anti-inflammatory inhaled drugs.
- Copyright ©ERS 2015