Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study
Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study
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DOI：
10.1183/23120541.00246-2019
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发表时间：
2020-01-01
影响因子：
4.6
通讯作者：
Nagase, Takahide
中科院分区：
文献类型：
--
作者：
Jo, Taisuke;Yasunaga, Hideo;Nagase, Takahide
背景：吸入性皮质类固醇（ICS）用于晚期慢性阻塞性肺疾病（COPD）。ICS撤药的应用和安全性仍存在争议。本研究旨在评估ICS撤药与COPD伴或不伴支气管哮喘的老年患者的预后之间的相关性，COPD伴或不伴支气管哮喘的老年患者因急性加重而住院治疗。我们确定了因COPD急性加重而住院的年龄>= 65岁的患者。使用倾向评分分析，即1-2倾向评分匹配和稳定的治疗加权逆概率，比较了退出和继续ICS的患者因COPD急性加重或死亡而再次住院、出院后抗菌药物处方频率和口服皮质类固醇处方频率。结果：在3735例合格患者中，分别有971例和2764例患者停用和继续使用ICS。在倾向评分匹配中，与继续治疗相比，因COPD急性加重而再次住院或因ICS停药而死亡的风险比（95%置信区间）为0.65（0.52-0.80），治疗加权的逆概率为0.71（0.56-0.90）。在ICS停药组中，1年内使用抗生素处方而非皮质类固醇处方的频率显著较低。在共病支气管哮喘患者中，ICS撤药与COPD急性加重或死亡的再住院率降低显著相关，仅在倾向评分匹配analysis.Conclusion：COPD急性加重后ICS撤药与老年患者（包括共病支气管哮喘患者）的再住院率或死亡率降低显著相关。
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.