Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts
Abstract Background This cohort study of patients with chronic obstructive pulmonary disease (COPD) was performed to evaluate the status of inhaled corticosteroid (ICS) prescriptions following the 2017 revision of the Global Initiative for Chronic Obstructive Lung Disease guidelines. Methods A total...
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| Format: | Article |
| Language: | English |
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BMC
2019-03-01
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| Series: | Respiratory Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12931-019-1029-7 |
| _version_ | 1818294021520359424 |
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| author | Se Hee Lee Ji-Hyun Lee Ho Il Yoon Hye Yun Park Tae-Hyung Kim Kwang Ha Yoo Yeon-Mok Oh Ki Suk Jung Sang-Do Lee Sei Won Lee |
| author_facet | Se Hee Lee Ji-Hyun Lee Ho Il Yoon Hye Yun Park Tae-Hyung Kim Kwang Ha Yoo Yeon-Mok Oh Ki Suk Jung Sang-Do Lee Sei Won Lee |
| author_sort | Se Hee Lee |
| collection | DOAJ |
| description | Abstract Background This cohort study of patients with chronic obstructive pulmonary disease (COPD) was performed to evaluate the status of inhaled corticosteroid (ICS) prescriptions following the 2017 revision of the Global Initiative for Chronic Obstructive Lung Disease guidelines. Methods A total of 1144 patients from the Korean Obstructive Lung Disease and Korea Chronic Obstructive Pulmonary Disorders Subgroup Study cohorts, with final follow-up visits completed between 2017 and 2018, were analyzed. Features indicative of ICS usage were as follows: a history of asthma, blood eosinophils of ≥300 cells/μl, or ≥ 2 exacerbations in the year prior to enrollment. Among baseline ICS users, we compared annual total and severe exacerbation rates, based on ICS continuation or withdrawal. Results ICS-containing regimens were prescribed to 46.3% of the enrolled of patients in 2014; this decreased to 38.8% in 2017, and long-acting dual bronchodilators were used instead. Among ICS users in 2017, 47.5% did not exhibit features indicative of ICS usage; 478 used ICS at baseline, and ICS was withdrawn in 77 (16.1%) during the study period. The proportion of patients with asthma and the baseline annual exacerbation rate were greater in the ICS withdrawal groinup than in the ICS continued group (56.6% vs. 41%, p = 0.01; 0.79 vs. 0.53, p < 0.001). Annual exacerbation rates during the follow-up period were similar between the ICS-withdrawal and ICS -continued groups (0.48 vs. 0.47, p = 0.84); however, former exhibited a significantly higher rate of severe exacerbation (0.22 vs. 0.12, p = 0.03). Conclusions Prescriptions of ICS to treat COPD decreased with increased use of long-acting dual bronchodilators. ICS withdrawal might impact severe exacerbation; the potential risks and benefits of withdrawing ICS should therefore be considered based on patients’ characteristics. |
| first_indexed | 2024-12-13T03:25:07Z |
| format | Article |
| id | doaj.art-91f2f063d9ef44dbbd2e5ba1a4962807 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-13T03:25:07Z |
| publishDate | 2019-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-91f2f063d9ef44dbbd2e5ba1a49628072022-12-22T00:01:18ZengBMCRespiratory Research1465-993X2019-03-0120111010.1186/s12931-019-1029-7Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohortsSe Hee Lee0Ji-Hyun Lee1Ho Il Yoon2Hye Yun Park3Tae-Hyung Kim4Kwang Ha Yoo5Yeon-Mok Oh6Ki Suk Jung7Sang-Do Lee8Sei Won Lee9Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Internal Medicine, CHA Bundang Medical Center, CHA UniversityDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang HospitalDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDivision of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of MedicineDivision of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of MedicineDepartment of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of MedicineDivision of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical SchoolDepartment of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of MedicineAbstract Background This cohort study of patients with chronic obstructive pulmonary disease (COPD) was performed to evaluate the status of inhaled corticosteroid (ICS) prescriptions following the 2017 revision of the Global Initiative for Chronic Obstructive Lung Disease guidelines. Methods A total of 1144 patients from the Korean Obstructive Lung Disease and Korea Chronic Obstructive Pulmonary Disorders Subgroup Study cohorts, with final follow-up visits completed between 2017 and 2018, were analyzed. Features indicative of ICS usage were as follows: a history of asthma, blood eosinophils of ≥300 cells/μl, or ≥ 2 exacerbations in the year prior to enrollment. Among baseline ICS users, we compared annual total and severe exacerbation rates, based on ICS continuation or withdrawal. Results ICS-containing regimens were prescribed to 46.3% of the enrolled of patients in 2014; this decreased to 38.8% in 2017, and long-acting dual bronchodilators were used instead. Among ICS users in 2017, 47.5% did not exhibit features indicative of ICS usage; 478 used ICS at baseline, and ICS was withdrawn in 77 (16.1%) during the study period. The proportion of patients with asthma and the baseline annual exacerbation rate were greater in the ICS withdrawal groinup than in the ICS continued group (56.6% vs. 41%, p = 0.01; 0.79 vs. 0.53, p < 0.001). Annual exacerbation rates during the follow-up period were similar between the ICS-withdrawal and ICS -continued groups (0.48 vs. 0.47, p = 0.84); however, former exhibited a significantly higher rate of severe exacerbation (0.22 vs. 0.12, p = 0.03). Conclusions Prescriptions of ICS to treat COPD decreased with increased use of long-acting dual bronchodilators. ICS withdrawal might impact severe exacerbation; the potential risks and benefits of withdrawing ICS should therefore be considered based on patients’ characteristics.http://link.springer.com/article/10.1186/s12931-019-1029-7Bronchitis, chronicBronchodilator agentsEosinophilsGlucocorticoidsChronic obstructive pulmonary disease |
| spellingShingle | Se Hee Lee Ji-Hyun Lee Ho Il Yoon Hye Yun Park Tae-Hyung Kim Kwang Ha Yoo Yeon-Mok Oh Ki Suk Jung Sang-Do Lee Sei Won Lee Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts Respiratory Research Bronchitis, chronic Bronchodilator agents Eosinophils Glucocorticoids Chronic obstructive pulmonary disease |
| title | Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts |
| title_full | Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts |
| title_fullStr | Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts |
| title_full_unstemmed | Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts |
| title_short | Change in inhaled corticosteroid treatment and COPD exacerbations: an analysis of real-world data from the KOLD/KOCOSS cohorts |
| title_sort | change in inhaled corticosteroid treatment and copd exacerbations an analysis of real world data from the kold kocoss cohorts |
| topic | Bronchitis, chronic Bronchodilator agents Eosinophils Glucocorticoids Chronic obstructive pulmonary disease |
| url | http://link.springer.com/article/10.1186/s12931-019-1029-7 |
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