The Impact of Inhaled Corticosteroids on the Prognosis of Chronic Obstructive Pulmonary Disease

Ji Won Park; Yoonki Hong; Chin Kook Rhee; Hye Sook Choi; Kyungjoo Kim; Kwang Ha Yoo; Ki-Suck Jung; Joo Hun Park

doi:10.2147/COPD.S388367

The Impact of Inhaled Corticosteroids on the Prognosis of Chronic Obstructive Pulmonary Disease

Int J Chron Obstruct Pulmon Dis. 2023 May 2:18:733-743. doi: 10.2147/COPD.S388367. eCollection 2023.

Authors

Ji Won Park^#¹, Yoonki Hong^#², Chin Kook Rhee³, Hye Sook Choi⁴, Kyungjoo Kim³, Kwang Ha Yoo⁵, Ki-Suck Jung⁶, Joo Hun Park¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea.
² Department of Internal Medicine, Kangwon National University, Chuncheon, South Korea.
³ Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴ Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea.
⁵ Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea.
⁶ Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea.

^# Contributed equally.

Abstract

Background: A comprehensive analysis of the effects of inhaled corticosteroids (ICS) on COPD in a real-world setting is required due to safety concerns regarding ICS in COPD. This study aimed to explore the impact of ICS on the prognosis of Asian COPD patients in the real-life world.

Methods: We examined 978 COPD patients registered in the Korean National Health and Nutrition Examination Survey (KNHANES) database and with their data linked to Health Insurance and Review Assessment (HIRA) data. The outcome measures were ascertained by HIRA from January 1, 2009, to December 31, 2012. This study enrolled two arms; ICS users (N = 85, mean age = 66.7 ± 8.9 years) and non-ICS users (N = 893, mean age = 63.7 ± 9.7 years).

Results: Compared to the non-ICS users, the ICS users had a higher rate of pneumonia, tuberculosis, and acute exacerbations (P<0.05). Hospitalization due to respiratory causes was also higher among ICS users (P<0.05). Multivariate analysis showed that acute exacerbation was independently associated with the development of pneumonia (P<0.05), whereas ICS therapy had a tendency to be associated with pneumonia. Another multivariate analysis demonstrated that old age, FEV₁, ICS therapy, and pneumonia were independently associated with the occurrence of acute exacerbation (P<0.05). The concomitant pneumonia (HR = 3.353, P = 0.004) was independently associated with higher mortality (P<0.05).

Conclusion: Our data demonstrated that the ICS users had a higher rate of pneumonia and tuberculosis and the concomitant pneumonia was independently associated with higher mortality, highlighting the importance of cautious and targeted administration of ICS in COPD.

Keywords: COPD; inhaled corticosteroids; mortality; pneumonia.

MeSH terms

Adrenal Cortex Hormones / adverse effects
Aged
Humans
Insurance, Health
Middle Aged
Nutrition Surveys
Prognosis
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / drug therapy

Substances

Adrenal Cortex Hormones

Grants and funding

This work was supported by the research program funded from Korea National Institute of Health (Funding code 2016ER670100, 2016ER670101, 2016ER670102, 2018ER67100, 2018ER67101, 2018ER67102, and 2021ER120500) and by National Research Foundation of Korea funded from Korean Government (NRF-2021R1I1A3056129).