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Chronic obstructive pulmonary disease
COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months
  1. Pradeesh Sivapalan1,
  2. Truls Sylvan Ingebrigtsen2,
  3. Daniel Bech Rasmussen3,4,
  4. Rikke Sørensen5,
  5. Christian Madelaire Rasmussen6,
  6. Camilla Bjørn Jensen7,
  7. Kristine Højgaard Allin7,
  8. Josefin Eklöf1,
  9. Niels Seersholm1,
  10. Joergen Vestbo8,9 and
  11. Jens-Ulrik Stæhr Jensen1,10
  1. 1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
  2. 2Department of Respiratory Medicine, Amager and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
  3. 3Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Copenhagen University Hospital, Naestved, Denmark
  4. 4Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  5. 5Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  6. 6Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, Hellerup, Denmark
  7. 7Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
  8. 8Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  9. 9Manchester University NHS Foundation Trust, North West Lung Centre, Manchester, UK
  10. 10Department of Infectious Diseases, Rigshospitalet, PERSIMUNE, Copenhagen, Denmark
  1. Correspondence to Pradeesh Sivapalan; pradeesh.s{at}dadlnet.dk

Abstract

Introduction A large group of patients with chronic obstructive pulmonary disease (COPD) are exposed to an overload of oral corticosteroids (OCS) due to repeated exacerbations. This is associated with potential serious adverse effects. Therefore, we evaluated the impact of a recommended reduction of OCS duration in 2014 on the risk of pneumonia hospitalisation and all-cause mortality in patients with acute exacerbation of COPD (AECOPD).

Methods This was a nationwide observational cohort study that was based on linked administrative registry data between 1 January 2010 and 31 October 2017. 10 152 outpatients with COPD (median age 70 years) treated with either a short (≤250 mg) or long course (>250 mg) of OCS for AECOPD were included in the study. Cox proportional hazards regression models were used to derive an estimation of multivariable adjusted HRs (aHRs) for pneumonia hospitalisation or all-cause mortality combined and pneumonia hospitalisation and all-cause mortality, separately.

Results The long course of OCS treatment for AECOPD was associated with an increased 1-year risk of pneumonia hospitalisation or all-cause mortality (aHR 1.3, 95% CI 1.1 to 1.4; p<0.0001), pneumonia hospitalisation (aHR 1.2, 95% CI 1.0 to 1.3; p=0.0110) and all-cause mortality (aHR 1.8, 95% CI 1.5 to 2.2; p<0.0001) as compared with the short course of OCS treatment. These results were confirmed in several sensitivity analyses.

Conclusion The change of recommendations from long courses to short courses of OCS for AECOPD in 2014 was strongly associated with a decrease in pneumonia admissions and all-cause mortality, in favour of short courses of OCS.

  • copd exacerbations
  • copd pharmacology
  • pneumonia
  • copd epidemiology
  • clinical epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000407

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    Footnotes

    • Contributors All authors contributed to the conception and design of the work. Statistical analyses were done by PS with help from DBR, RS and J-USJ. All authors contributed to the interpretation of data. PS wrote the first draft of the manuscript with input from J-USJ, JV, RS and TSI. All authors critically revised the manuscript and approved the submitted version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work.

    • Funding The study was financed by a grant from The Danish Regions Medical Fund and The Danish Council for Independent Research. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication. JV is supported by the National Institute of Health Manchester Biomedical Research Centre.

    • Disclaimer The funders had no role in the study design, data collection and analysis, the decision to publish or the preparation of the manuscript.

    • Competing interests JV reports personal fees from GlaxoSmithKline, personal fees from Chiesi Pharmaceuticals, personal fees from Boehringer-Ingelheim, personal fees from Novartis, personal fees from AstraZeneca, outside the submitted work. TSI reports personal fees from AstraZeneca, outside the submitted work.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Danish Data Protection Agency (journal no. HGH-2017-091, with I-Suite no. 05884). As this study did not involve contact with patients or an intervention, it was not necessary to obtain permission from the Danish scientific ethical committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.