Effect of Added Inhaled Corticosteroids to Systemic Steroids on COPD Exacerbation Outcomes

医学 倾向得分匹配 慢性阻塞性肺病 恶化 混淆 回顾性队列研究 内科学 优势比 队列 插管 队列研究 麻醉
作者
Eyal Kleinhendler,Noa Shopen,Neta Cohen,Ophir Freund,Tal Moshe Perluk,Evgeni Gershman,Avraham Unterman,Amir Bar‐Shai
出处
期刊:Respiratory Care [Daedalus Enterprises]
卷期号:: respcare.11954-respcare.11954
标识
DOI:10.4187/respcare.11954
摘要

BACKGROUND:

COPD exacerbations are a major cause of morbidity and mortality. Although inhaled corticosteroids (ICS) have a role as long-term treatment, their efficacy in exacerbations, particularly as an adjunct to systemic steroids, remains unclear.

METHODS:

In this retrospective observational study, we analyzed data from 870 subjects admitted with COPD exacerbations to a tertiary medical center in Israel from January 2018–January 2023. We investigated the impact of adding ICS to standard systemic steroid treatment on hospital length of stay, intubation rates, and 30-d mortality using propensity score matching to account for confounders.

RESULTS:

The cohort, after matching, included 354 subjects treated with systemic steroids and ICS and 121 treated with systemic steroids alone. All characteristics were similar between the groups. Our analysis showed no differences in 30-d mortality (7.1% vs 5.8%, P = .63) or secondary outcomes (intubation, hospital length of stay, and readmission rates) between the groups. Subgroup analyses based on different eosinophil levels did not alter these findings. In multivariate analysis among the general cohort, eosinophil count < 150 cells/μL (adjusted odds ratio 0.45 [95% CI 0.21–0.87], P = .02) and high Charlson score (adjusted odds ratio 1.19 [95% CI 1.02–1.37], P = .02) were independent predictors for 30-d mortality.

CONCLUSIONS:

Despite the known benefits of ICS in managing chronic COPD, we did not find an added value of ICS to systemic steroids in exacerbations. These results underscore the necessity for individualized treatment strategies and further research into the role of ICS in COPD exacerbations.

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