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Effectiveness and safety of inhaled corticosteroids in older individuals with COPD and/or asthma: a population study

Kendzerska T, Aaron SD, To T, Licskai C, Stanbrook M, Vozoris N, Hogan ME, Tan WC, Bourbeau J, Gershon AS, Canadian Respiratory Research Network. Ann Am Thorac Soc. 2019; Jul 12 [Epub ahead of print]. DOI: 10.1513/AnnalsATS.201902-126OC.

Rationale — Inhaled corticosteroids (ICS) are established medications for the management of both asthma and chronic obstructive pulmonary disease (COPD), two common chronic airway diseases. However, there is still uncertainty with respect to their use in some areas, specifically for asthma in older adults, for people with concurrent asthma and COPD and for some people with COPD given their association with pneumonia.

Objectives — To compare the effectiveness and safety of ICS in older adults with asthma, COPD or features of both in a real-word setting.

Methods — In this retrospective longitudinal population cohort study, individuals aged 66 years or older in Ontario, Canada who met a validated case definition of physician-diagnosed COPD and/or asthma between 2003 and 2014 were followed until March 2015 through provincial health administrative data. Overlap in COPD and asthma diagnoses was permitted and stratified for in subgroup analyses. The exposure was new receipt of ICS. Primary effectiveness and safety outcomes were, respectively, hospitalizations for obstructive lung disease (OLD) and hospitalizations for pneumonia. Propensity scores were used to adjust for confounders.

Results — There were 87,690 individuals with asthma (27% with concurrent COPD) and 150,593 with COPD (25% with concurrent asthma). In terms of effectiveness, controlling for confounders, ICS was associated with fewer OLD hospitalizations (HR 0.84, 0.79-0.88) in those with asthma alone with concurrent COPD attenuating the benefit; a similar association was seen in those with COPD and concurrent asthma (HR 0.88, 0.84-0.92), but not in those with COPD alone where ICS receipt had little impact on hospitalizations. In terms of safety, ICS receipt was associated with a marginal increased risk of pneumonia hospitalizations in people with COPD and no asthma (HR 1.03, 1.00-1.06), but not in the other groups.

Conclusions — ICS was associated with fewer obstructive lung disease hospitalizations in older adults with asthma and concurrent asthma and COPD but had little impact on obstructive lung disease and pneumonia hospitalizations in those with COPD alone.