Survival of COPD patients using inhaled corticosteroids and long-acting beta agonists

被引:25
作者
Mapel, DW
Hurley, JS
Roblin, D
Roberts, M
Davis, KJ
Schreiner, R
Frost, FJ
机构
[1] Lovelace Clin Fdn, Albuquerque, NM 87106 USA
[2] Lovelace Resp Res Inst, Ctr harmacoecon & Outcomes Res, Albuquerque, NM 87108 USA
[3] Kaiser Permanente Georgia Hlth Plan, Atlanta, GA 30305 USA
[4] GlaxoSmithKline Res & Dev Ltd, Res Triangle Pk, NC 27709 USA
关键词
chronic obstructive pulmonary disease; survival; asthma; corticosteroids; bronchodilators; gender;
D O I
10.1016/j.rmed.2005.08.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We conducted a historical cohort study to examine the relationship between survival and use of inhaled corticosteroids (ICS) and/or long-acting beta agonists (LABA) in patients with chronic obstructive pulmonary disease (COPD). All COPD patients aged >= 40 years who were enrolled in one of two regional managed care organizations during 1995-2000, and who had >= 90 days use of an ICS and/or LABA (N = 1288) or of a short-acting bronchodilator (N = 397), were identified. Of patients treated with ICS and/or LABA, 14.4% died during the follow-up period, as compared to 28.2% of comparison patients (P < 0.01). In a Cox proportional hazards model that controlled for age, sex, comorbidities, COPD severity, and asthma status, a reduced risk of death was found for ICS treatment (HR 0.59 [95% CI 0.46-0.78]), LABA (HR 0.55 [0.34-0.89]), and ICS plus LABA treatment (HR 0.34 [0.21-0.56]). A second model that excluded any patient who also had an ICD-9 code for asthma (N = 840) still found improved survival among those using the combination of ICS plus LABA (HR 0.35 [CI 0.17-0.71]). Additional analyses that varied the exposure criteria also found a consistent treatment benefit. Inclusion of ICS or bronchodilator treatment during the follow-up period as a time-dependent function appears to negate the survival benefit; however, the underlying assumptions for valid time-dependent modeling are clearly violated in this situation. In conclusion, we found that COPD patients who used ICS alone or in combination with LABA had substantially improved survival even after adjustment for asthma and other confounding factors. (c) 2005 Elsevier Ltd. All rights reserved.
引用
收藏
页码:595 / 609
页数:15
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