Probability and determinants of relapse after discontinuation of inhaled corticosteroids in patients with COPD treated in general practice.
OBJECTIVE
The objective of the study was to assess the probability, and explore determinants of adverse respiratory outcome after discontinuation of inhaled corticosteroid (ICS) treatment in subjects with chronic obstructive pulmonary disease (COPD) diagnosed and treated in general practice.


METHODS
Prospective unblinded ICS withdrawal study.


METHODS
201 ICS treated COPD patients with various degrees of airflow limitation from 45 Dutch general practices.


METHODS
Probability of and time to exacerbation or unremitting worsening of respiratory symptoms after ICS discontinuation.


RESULTS
Mean age was 60.6 (S.D. 9.5) years, post-bronchodilator forced expiratory volume in 1s (FEV1) 65.6 (S.D. 15.7) % predicted. Overall probability of adverse respiratory outcome after ICS discontinuation was 0.37 (95% confidence interval (CI) 0.31, 0.44). Survival analysis showed that age, gender, smoking status and reversibility of airflow limitation were independent predictors of adverse respiratory outcome. For females, the adjusted hazard ratio was 2.14 (95% CI 1.31, 3.50) compared to males. For age, the hazard ratio was 1.05 (95% CI 1.02, 1.08) per year lived.


CONCLUSIONS
Discontinuation of inhaled corticosteroids may harm patients with COPD. The probability of an adverse respiratory outcome may be higher in women, elderly patients, smokers and patients with higher bronchodilator reversibility while on inhaled steroid treatment.
Schermer
T R J
TR
Department of General Practice/Family Medicine, University Medical Centre Nijmegen, 229-HAG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Hendriks
A J C
AJ
Chavannes
N H
NH
Dekhuijzen
P N R
PN
Wouters
E F M
EF
van den Hoogen
H
H
van Schayck
C P
CP
van Weel
C
C