Despite widespread use of inhaled corticosteroids (ICS) for the treatment of COPD, the effectiveness of ICS for the treatment of COPD in a “real world” clinical practice setting has not been established.
We conducted a nested case control study to evaluate the effectiveness of ICS for the treatment of severe COPD in a large closed panel HMO. A source population of 830 adults HMO members aged 55 years or older who were hospitalized for COPD during a 1 year period was identified. From this group, we identified 121 cases who were subsequently re-hospitalized during the ensuing year and 362 controls who were matched on age, sex, and time of initial hospitalization. ICS and other medication dispensing were ascertained for the 3-, 6-, and 12-month periods preceding hospitalization. Low and high level ICS use was defined at the median among those who had any use.
Cases had greater dispensing of ICS during the three months preceding re-hospitalization than controls. Although the proportion receiving any ICS units was similar, cases were more likely to have high level dispensing (27% vs. 14%, p=0.002). Low level ICS dispensing was associated with a lower risk of re-hospitalization for COPD, controlling for other medication use (OR 0.49; 95% CI 0.24 to 0.98). There was no association between high level ICS use and re-hospitalization, controlling for covariates (OR 1.51; 95% CI 0.81 to 2.80).CONCLUSIONS: ICS are effective in reducing the risk of hospitalization among adults with severe COPD.
Although ICS have benefit for the treatment of COPD, smoking prevention and cessation remain the most important interventions.
M.D. Eisner, None.