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

doi:10.1136/bmjresp-2019-000407

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

Copenhagen University Hospital
Rigshospitalet
Bispebjerg and Frederiksberg Hospitals
University of Manchester

Research output: Contribution to journal › Journal article › Research › peer-review

150 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 language	English
Article number	e000407
Journal	BMJ Open Respiratory Research
Volume	6
Issue number	1
Number of pages	8
ISSN	2052-4439
DOIs	https://doi.org/10.1136/bmjresp-2019-000407
Publication status	Published - Mar 2019

Funding

BMI, body mass index; COPD, chronic obstructive pulmonary disease; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; MRC, Medical Research Council Dyspnoea Scale; OCS, oral corticosteroids. Both treatments were given during their respective periods as first line treatments – providing a comparison that mitigates the possibility that long course was given for the most severity of COPD patients. The study was approved by the Danish Data Protection Agency (journal number: HGH-2017-091, with I-Suite no.: 05884). 1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark 2Department of Respiratory Medicine, Amager and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark 3Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Copenhagen University Hospital, Naestved, Denmark 4Department of Regional Health Research, University of Southern Denmark, Odense, Denmark 5Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark 6Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, Hellerup, Denmark 7Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark 8Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK 9Manchester University NHS Foundation Trust, North West Lung Centre, Manchester, UK 10Department of Infectious Diseases, Rigshospitalet, PERSIMUNE, Copenhagen, Denmark 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.

Keywords

clinical epidemiology
COPD epidemiology
COPD exacerbations
COPD pharmacology
pneumonia

Documents & Links

10.1136/bmjresp-2019-000407Licence: CC BY-NC

COPD exacerbationsFinal published version, 530 KBLicence: CC BY-NC

SDU Link

Check access to the material in SDU Library's search engine

Cite this

Sivapalan, P., Ingebrigtsen, T. S., Rasmussen, D. B., Sørensen, R., Rasmussen, C. M., Jensen, C. B., Allin, K. H., Eklöf, J., Seersholm, N., Vestbo, J., & Jensen, J.-U. S. (2019). 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. BMJ Open Respiratory Research, 6(1), Article e000407. https://doi.org/10.1136/bmjresp-2019-000407

@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 = mar,

doi = "10.1136/bmjresp-2019-000407",

language = "English",

volume = "6",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

publisher = "B M J Group",

number = "1",

}

Sivapalan, P, Ingebrigtsen, TS, Rasmussen, DB, Sørensen, R, Rasmussen, CM, Jensen, CB, Allin, KH, Eklöf, J, Seersholm, N, Vestbo, J & Jensen, J-US 2019, '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', BMJ Open Respiratory Research, vol. 6, no. 1, e000407. https://doi.org/10.1136/bmjresp-2019-000407

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

Research output: Contribution to journal › Journal article › Research › peer-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

C2 - 31179005

AN - SCOPUS:85063660430

SN - 2052-4439

VL - 6

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

IS - 1

M1 - e000407

ER -

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

Funding

Keywords

Documents & Links

SDU Link

Fingerprint

Cite this