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

journal article Mar 01, 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

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

BMJ Open Respiratory Research Vol. 6 No. 1 pp. e000407 · BMJ

View at Publisher Save 10.1136/bmjresp-2019-000407

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.

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References

Details

Published: Mar 01, 2019
Vol/Issue: 6(1)
Pages: e000407

Authors

P

Pradeesh Sivapalan

Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark

T

Truls Sylvan Ingebrigtsen

Department of Respiratory Medicine, Amager and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark

D

Daniel Bech Rasmussen

Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Copenhagen University Hospital, Naestved, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

R

Rikke Sørensen

Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

C

Christian Madelaire Rasmussen

Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, Hellerup, Denmark

C

Camilla Bjørn Jensen

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark

K

Kristine Højgaard Allin

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark

J

Josefin Eklöf

Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark

N

Niels Seersholm

Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark

J

Joergen Vestbo

Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Manchester University NHS Foundation Trust, North West Lung Centre, Manchester, UK

J

Jens-Ulrik Stæhr Jensen

Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark; Department of Infectious Diseases, Rigshospitalet, PERSIMUNE, Copenhagen, Denmark

Funding

The Danish Council for Independent Research Award: 6110-00268

The Danish Regions Medical Fund Award: Sag nr. 15/1716

Cite This Article

Pradeesh Sivapalan, Truls Sylvan Ingebrigtsen, Daniel Bech Rasmussen, et al. (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), 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

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