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Effectiveness of Inhaled Steroids for the Treatment of COPD FREE TO VIEW

Mark D. Eisner, MD, MPH; Irina V. Tolstykh, MS; Carlos Iribarren, MD, PhD, MPH
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University of California, San Francisco, CA


Chest. 2003;124(4_MeetingAbstracts):99S. doi:10.1378/chest.124.4_MeetingAbstracts.99S
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PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CLINICAL IMPLICATIONS:  Although ICS have benefit for the treatment of COPD, smoking prevention and cessation remain the most important interventions.

DISCLOSURE:  M.D. Eisner, None.

Tuesday, October 28, 2003

10:30 AM - 12:00 PM




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