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

Taisuke Jo; Hideo Yasunaga; Yasuhiro Yamauchi; Akihisa Mitani; Yoshihisa Hiraishi; Wakae Hasegawa; Yukiyo Sakamoto; Hiroki Matsui; Kiyohide Fushimi; Takahide Nagase

doi:10.1183/23120541.00246-2019

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

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

Authors

Affiliations

¹ Dept of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Dept of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁴ Dept of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.

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.