Vollmer William M, Peters Dawn, Crane Bradley, Kelleher Christopher, Buist A Sonia
Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227-1110, USA.
COPD. 2007 Jun;4(2):135-42. doi: 10.1080/15412550701341186.
Inhaled corticosteroids are often used to manage chronic obstructive pulmonary disease, although the evidence regarding their long-term efficacy in preventing or reducing adverse health outcomes is not definitive. This retrospective cohort study analyzed whether regular inhaled corticosteroid use is associated with reduced health care utilization and all-cause mortality related to chronic obstructive pulmonary disease. Subjects were 2,902 health maintenance organization members aged 50 and over who met criteria for chronic obstructive pulmonary disease. The study used a composite endpoint of time to (1) death or (2) hospitalization or emergency room care related to chronic obstructive pulmonary disease, whichever occurred first, during a 4-year follow-up. Among the 42% of chronic obstructive pulmonary disease patients with an indication of co-morbid asthma, inhaled corticosteroid use was associated with significantly reduced risk for both all-cause mortality and the composite outcome. The reduction in risk was greatest in never- and ex-smokers. Among chronic obstructive pulmonary disease patients with no indication of asthma, inhaled corticosteroid use was associated with reduced risk only in never smokers. These findings generally persisted in separate analyses stratified by asthma status and in sensitivity analyses using four alternative definitions of regular medication use, with comparable results when regular medication use was treated as a fixed covariate defined at the start of follow-up. We conclude that use of inhaled corticosteroids was associated with reduced risk of chronic obstructive pulmonary disease exacerbations and all-cause mortality. This benefit was most pronounced among never-smokers and in those with evidence of co-morbid asthma.
吸入性糖皮质激素常用于治疗慢性阻塞性肺疾病，尽管其在预防或减少不良健康结局方面的长期疗效证据并不确凿。这项回顾性队列研究分析了规律使用吸入性糖皮质激素是否与降低慢性阻塞性肺疾病相关的医疗保健利用率和全因死亡率有关。研究对象为2902名年龄在50岁及以上、符合慢性阻塞性肺疾病标准的健康维护组织成员。该研究采用了一个复合终点，即在4年随访期间，以（1）死亡或（2）与慢性阻塞性肺疾病相关的住院或急诊就诊时间为准，以先发生者为准。在42%有合并哮喘指征的慢性阻塞性肺疾病患者中，使用吸入性糖皮质激素与全因死亡率和复合结局的风险显著降低相关。风险降低在从不吸烟者和已戒烟者中最为明显。在无哮喘指征的慢性阻塞性肺疾病患者中，仅从不吸烟者使用吸入性糖皮质激素与风险降低相关。这些发现通常在按哮喘状态分层的单独分析以及使用四种常规药物使用替代定义的敏感性分析中持续存在，当将常规药物使用作为随访开始时定义的固定协变量进行处理时，结果相似。我们得出结论，使用吸入性糖皮质激素与降低慢性阻塞性肺疾病急性加重风险和全因死亡率相关。这种益处在从不吸烟者和有合并哮喘证据的患者中最为明显。
