Abstract
Objectives:
To assess the probability and explore determinants of an adverse respiratory outcome after discontinuation of inhaled corticosteroid treatment in subjects with chronic obstructive pulmonary disease (COPD) diagnosed in general practice. Design - Prospective observational inhaled steroid withdrawal study.
Setting:
45 Dutch general practices. Participants - 232 subjects with a general practice based diagnosis of COPD with various degrees of airflow limitation. All subjects were treated with inhaled steroids.
Main outcome measures:
Probability of, and time to an adverse respiratory event within 3 to 7 months after inhaled steroid withdrawal.
Results:
Overall probability of an adverse respiratory event was 0.37 (95% CI 0.31, 0.44). Mean number of days until adverse respiratory event was lowest when steroid withdrawal was initiated in January through April and July through August (p=0.072). Univariately, those experiencing an adverse respiratory event tended to be more often female, were older and showed higher reversibility of airflow limitation. Multivariate survival analysis resulted in a hazard ratio for females of 2.14 (95% CI 1.31, 3.50) compared to males. For age, the hazard ratio was 1.05 (95% CI 1.02, 1.08) per year of increased age. Depending on the baseline inhaled steroid dosage, age, gender, smoking status and reversibility were independent predictors of adverse respiratory event after discontinuation of inhaled steroid treatment.
Conclusions:
Abrupt withdrawal of inhaled steroids is likely to harm at least some patients with COPD. Probability of an adverse respiratory response after inhaled steroid withdrawal may vary throughout the year and appears to be higher in women, elderly subjects, smokers and subjects with reversible airflow limitation.
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