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Effects of inhaled corticosteroids /long-acting agonists in a single inhaler versus inhaled corticosteroids alone on all-cause mortality, pneumonia, and fracture in chronic obstructive pulmonary disease: A nationwide cohort study 2002-2013.
Respir Med. 2017 Sep; 130:75-84.RM

Abstract

BACKGROUND

Both inhaled corticosteroids (ICS) and long-acting ?-agonists (LABA) have been recommended for the treatment of severe/moderate chronic obstructive pulmonary disease (COPD), but mild COPD has not been frequently studied.

METHODS

We performed a prospective cohort study to compare the effect of inhaled corticosteroid (ICS) and ICS/long-acting ?-agonist (LABA) in a single inhaler on all-cause mortality and adverse events, such as pneumonia and fracture, in patients with newly diagnosed chronic obstructive pulmonary disease (COPD). We used representative nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). Patients who were at least 40-years-old, newly diagnosed with COPD, and prescribed ICS or ICS/LABA in a single inhaler (N = 1995). To analyze the data, we utilized a Cox's proportional hazard regression.

RESULTS

Among the total of 1995 patients, 807 had severe COPD (FEV1 < 50%) and 1188 had mild/moderate COPD (FEV1 ? 50%). The cumulative incidence and 5-year cumulative incidence of all-cause mortality was 59.5% and 29.6% for ICS users, and 35.8% and 20.2% for single inhaler ICS/LABA users, respectively. The adjusted hazard ratio (HR) of all-cause mortality for new ICS/LABA users, compared with that in new ICS users, was 0.77 (95% CI: 0.62-0.95) for the total population. For the severe and non-severe COPD groups, the adjusted HRs of all-cause mortality for new ICS/LABA users were 1.07 (95% CI: 0.65-1.76) and 0.70 (95% CI: 0.55-0.89), respectively. There was no difference in the risk for the first hospitalization due to pneumonia between new ICS and ICS/LABA users among the total population (HR: 1.02; 95% CI: 0.79-1.34). The adjusted HR of the first hospitalization for fractures in new ICS/LABA users, compared with that in new ICS users, was 0.60 (95% CI: 0.39-0.92) for the total population.

CONCLUSIONS

Among newly diagnosed COPD patients and new users of ICS or ICS/LABA, use of ICS/LABA in a single inhaler was associated with lowered risk of all-cause mortality and delayed first hospitalization for fracture, as compared with use of ICS alone. However, there was no significant difference in terms of first hospitalization for pneumonia.

Authors+Show Affiliations

Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea.Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, South Korea.International Health Care Center, Severance Hospital, Yonsei University, Seoul, South Korea.Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea; Department of Biostatistics, College of Medicine, Yonsei University, Seoul, South Korea.Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea.Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, South Korea; Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea. Electronic address: ECPARK@yuhs.ac.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29206637

Citation

Cho, Kyoung Hee, et al. "Effects of Inhaled Corticosteroids /long-acting Agonists in a Single Inhaler Versus Inhaled Corticosteroids Alone On All-cause Mortality, Pneumonia, and Fracture in Chronic Obstructive Pulmonary Disease: a Nationwide Cohort Study 2002-2013." Respiratory Medicine, vol. 130, 2017, pp. 75-84.
Cho KH, Kim YS, Linton JA, et al. Effects of inhaled corticosteroids /long-acting agonists in a single inhaler versus inhaled corticosteroids alone on all-cause mortality, pneumonia, and fracture in chronic obstructive pulmonary disease: A nationwide cohort study 2002-2013. Respir Med. 2017;130:75-84.
Cho, K. H., Kim, Y. S., Linton, J. A., Nam, C. M., Choi, Y., & Park, E. C. (2017). Effects of inhaled corticosteroids /long-acting agonists in a single inhaler versus inhaled corticosteroids alone on all-cause mortality, pneumonia, and fracture in chronic obstructive pulmonary disease: A nationwide cohort study 2002-2013. Respiratory Medicine, 130, 75-84. https://doi.org/10.1016/j.rmed.2017.07.012
Cho KH, et al. Effects of Inhaled Corticosteroids /long-acting Agonists in a Single Inhaler Versus Inhaled Corticosteroids Alone On All-cause Mortality, Pneumonia, and Fracture in Chronic Obstructive Pulmonary Disease: a Nationwide Cohort Study 2002-2013. Respir Med. 2017;130:75-84. PubMed PMID: 29206637.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of inhaled corticosteroids /long-acting agonists in a single inhaler versus inhaled corticosteroids alone on all-cause mortality, pneumonia, and fracture in chronic obstructive pulmonary disease: A nationwide cohort study 2002-2013. AU - Cho,Kyoung Hee, AU - Kim,Young Sam, AU - Linton,John A, AU - Nam,Chung Mo, AU - Choi,Young, AU - Park,Eun-Cheol, Y1 - 2017/07/19/ PY - 2017/01/13/received PY - 2017/07/16/revised PY - 2017/07/17/accepted PY - 2017/12/6/entrez PY - 2017/12/6/pubmed PY - 2018/8/3/medline KW - Adverse events KW - All-cause mortality KW - Chronic obstructive pulmonary disease KW - ICS/LABA in a single inhaler KW - Inhaled corticosteroids KW - Long-acting ?-agonists SP - 75 EP - 84 JF - Respiratory medicine JO - Respir Med VL - 130 N2 - BACKGROUND: Both inhaled corticosteroids (ICS) and long-acting ?-agonists (LABA) have been recommended for the treatment of severe/moderate chronic obstructive pulmonary disease (COPD), but mild COPD has not been frequently studied. METHODS: We performed a prospective cohort study to compare the effect of inhaled corticosteroid (ICS) and ICS/long-acting ?-agonist (LABA) in a single inhaler on all-cause mortality and adverse events, such as pneumonia and fracture, in patients with newly diagnosed chronic obstructive pulmonary disease (COPD). We used representative nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). Patients who were at least 40-years-old, newly diagnosed with COPD, and prescribed ICS or ICS/LABA in a single inhaler (N = 1995). To analyze the data, we utilized a Cox's proportional hazard regression. RESULTS: Among the total of 1995 patients, 807 had severe COPD (FEV1 < 50%) and 1188 had mild/moderate COPD (FEV1 ? 50%). The cumulative incidence and 5-year cumulative incidence of all-cause mortality was 59.5% and 29.6% for ICS users, and 35.8% and 20.2% for single inhaler ICS/LABA users, respectively. The adjusted hazard ratio (HR) of all-cause mortality for new ICS/LABA users, compared with that in new ICS users, was 0.77 (95% CI: 0.62-0.95) for the total population. For the severe and non-severe COPD groups, the adjusted HRs of all-cause mortality for new ICS/LABA users were 1.07 (95% CI: 0.65-1.76) and 0.70 (95% CI: 0.55-0.89), respectively. There was no difference in the risk for the first hospitalization due to pneumonia between new ICS and ICS/LABA users among the total population (HR: 1.02; 95% CI: 0.79-1.34). The adjusted HR of the first hospitalization for fractures in new ICS/LABA users, compared with that in new ICS users, was 0.60 (95% CI: 0.39-0.92) for the total population. CONCLUSIONS: Among newly diagnosed COPD patients and new users of ICS or ICS/LABA, use of ICS/LABA in a single inhaler was associated with lowered risk of all-cause mortality and delayed first hospitalization for fracture, as compared with use of ICS alone. However, there was no significant difference in terms of first hospitalization for pneumonia. SN - 1532-3064 UR - https://www.unboundmedicine.com/medline/citation/29206637/Effects_of_inhaled_corticosteroids_/long_acting_agonists_in_a_single_inhaler_versus_inhaled_corticosteroids_alone_on_all_cause_mortality_pneumonia_and_fracture_in_chronic_obstructive_pulmonary_disease:_A_nationwide_cohort_study_2002_2013_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(17)30212-3 DB - PRIME DP - Unbound Medicine ER -