Dose dependent increased mortality risk in COPD patients treated with oralglucocorticoids

Systemic corticosteroids are often administered in COPD patients. The relat ionship between systemic glucocorticoids and mortality in patients with mod erate to severe chronic obstructive pulmonary disease (COPD) was retrospect ively analysed. Baseline characteristics of the patients, in stable clinica l condition, were collected on admission to a pulmonary rehabilitation cent re. Overall mortality was asessed at the end of follow-up. The Cox proporti onal hazards model was used to quantify the relationship between glucocorti coid use, distinguishing administration route (oral/inhalation) and oral do se, and overall mortality, adjusted for the influence of age, sex, smoking, lung function, resting arterial blood gases and body mass index. On multvariate analysis, oral glucocorticoid use at a (prednisone equivalen t) dose of 10 mg(.)day(-1) without inhaled glucocorticoids, was associated with an increased risk (RR = 2.34, 95% confidence interval (CI) 1.24-4.44) while 15 mg(.)day(-1) carried a relative risk of 4.03, CI = 1.99-8.15). A s ignificant interaction was observed between inhaled and oral glucocorticoid use. Combined with inhaled glucocorticoids, the relative risk of oral gluc ocorticoid use appeared to be significantly smaller. It is concluded that in severe chronic obstructive pulmonary disease, maint enance treatment with oral glucocorticoids is associated with increased mor tality in a dose-dependent manner. Since the present study design cannot ex clude the possibility of bias by indication, further prospective studies ar e indicated using a broader patient characterization.