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

Pradeesh Sivapalan*, Truls Sylvan Ingebrigtsen, Daniel Bech Rasmussen, Rikke Sørensen, Christian Madelaire Rasmussen, Camilla Bjørn Jensen, Kristine Højgaard Allin, Josefin Eklöf, Niels Seersholm, Joergen Vestbo, Jens-Ulrik Stæhr Jensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

79 Downloads (Pure)

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.

Original languageEnglish
Article numbere000407
JournalBMJ Open Respiratory Research
Volume6
Issue number1
Number of pages8
ISSN2052-4439
DOIs
Publication statusPublished - Mar 2019

Fingerprint

Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Proportional Hazards Models
Registries
Cohort Studies
Outpatients

Keywords

  • clinical epidemiology
  • COPD epidemiology
  • COPD exacerbations
  • COPD pharmacology
  • pneumonia

Cite this

Sivapalan, Pradeesh ; Ingebrigtsen, Truls Sylvan ; Rasmussen, Daniel Bech ; Sørensen, Rikke ; Rasmussen, Christian Madelaire ; Jensen, Camilla Bjørn ; Allin, Kristine Højgaard ; Eklöf, Josefin ; Seersholm, Niels ; Vestbo, Joergen ; Jensen, Jens-Ulrik Stæhr. / 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. In: BMJ Open Respiratory Research. 2019 ; Vol. 6, No. 1.
@article{987308c166b94ac29d3154ab02137226,
title = "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",
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.",
keywords = "clinical epidemiology, COPD epidemiology, COPD exacerbations, COPD pharmacology, pneumonia",
author = "Pradeesh Sivapalan and Ingebrigtsen, {Truls Sylvan} and Rasmussen, {Daniel Bech} and Rikke S{\o}rensen and Rasmussen, {Christian Madelaire} and Jensen, {Camilla Bj{\o}rn} and Allin, {Kristine H{\o}jgaard} and Josefin Ekl{\"o}f and Niels Seersholm and Joergen Vestbo and Jensen, {Jens-Ulrik St{\ae}hr}",
year = "2019",
month = "3",
doi = "10.1136/bmjresp-2019-000407",
language = "English",
volume = "6",
journal = "B M J Open Respiratory Research",
issn = "2052-4439",
publisher = "B M J Group",
number = "1",

}

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. / Sivapalan, Pradeesh; Ingebrigtsen, Truls Sylvan; Rasmussen, Daniel Bech; Sørensen, Rikke; Rasmussen, Christian Madelaire; Jensen, Camilla Bjørn; Allin, Kristine Højgaard; Eklöf, Josefin; Seersholm, Niels; Vestbo, Joergen; Jensen, Jens-Ulrik Stæhr.

In: BMJ Open Respiratory Research, Vol. 6, No. 1, e000407, 03.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - COPD exacerbations: The impact of long versus short courses of oral corticosteroids on mortality and pneumonia

T2 - Nationwide data on 67 000 patients with COPD followed for 12 months

AU - Sivapalan, Pradeesh

AU - Ingebrigtsen, Truls Sylvan

AU - Rasmussen, Daniel Bech

AU - Sørensen, Rikke

AU - Rasmussen, Christian Madelaire

AU - Jensen, Camilla Bjørn

AU - Allin, Kristine Højgaard

AU - Eklöf, Josefin

AU - Seersholm, Niels

AU - Vestbo, Joergen

AU - Jensen, Jens-Ulrik Stæhr

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - clinical epidemiology

KW - COPD epidemiology

KW - COPD exacerbations

KW - COPD pharmacology

KW - pneumonia

U2 - 10.1136/bmjresp-2019-000407

DO - 10.1136/bmjresp-2019-000407

M3 - Journal article

VL - 6

JO - B M J Open Respiratory Research

JF - B M J Open Respiratory Research

SN - 2052-4439

IS - 1

M1 - e000407

ER -