Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease.
BACKGROUND
Clinical studies suggest that inhaled corticosteroids reduce exacerbations and improve health status in chronic obstructive pulmonary disease (COPD). However, their effect on mortality is unknown.


METHODS
A pooled analysis, based on intention to treat, of individual patient data from seven randomised trials (involving 5085 patients) was performed in which the effects of inhaled corticosteroids and placebo were compared over at least 12 months in patients with stable COPD. The end point was all-cause mortality.


RESULTS
Overall, 4% of the participants died during a mean follow up period of 26 months. Inhaled corticosteroids reduced all-cause mortality by about 25% relative to placebo. Stratification by individual trials and adjustments for age, sex, baseline post-bronchodilator percentage predicted forced expiratory volume in 1 second, smoking status, and body mass index did not materially change the results (adjusted hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.55 to 0.96). Although there was considerable overlap between subgroups in terms of effect sizes, the beneficial effect was especially noticeable in women (adjusted HR 0.46; 95% CI 0.24 to 0.91) and former smokers (adjusted HR 0.60; 95% CI 0.39 to 0.93).


CONCLUSIONS
Inhaled corticosteroids reduce all-cause mortality in COPD. Further studies are required to determine whether the survival benefits persist beyond 2-3 years.
Sin
D D
DD
James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St Paul's Hospital, 1081 Burrard Street, and Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6. dsin@mrl.ubc.ca
Wu
L
L
Anderson
J A
JA
Anthonisen
N R
NR
Buist
A S
AS
Burge
P S
PS
Calverley
P M
PM
Connett
J E
JE
Lindmark
B
B
Pauwels
R A
RA
Postma
D S
DS
Soriano
J B
JB
Szafranski
W
W
Vestbo
J
J
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002423:Cause of Death; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
D000305:Adrenal Cortex Hormones