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Coexisting COPD Increases Mortality in Patients With Corticosteroid-Dependent Asthma: A Nationwide Population-Based
Hyun Lee1, Jiin Ryu2, Sung Jun Chung1
1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Insights
Patients with asthma requiring corticosteroid (CS) therapy and coexisting chronic obstructive pulmonary disease (COPD) face higher mortality risks. Early COPD recognition and management are crucial for improving outcomes in these patients.
Area of Science:
- Pulmonology
- Epidemiology
- Clinical Medicine
Background:
- Chronic corticosteroid (CS) use is a known mortality risk factor in asthma patients.
- Coexisting chronic obstructive pulmonary disease (COPD) in asthma is linked to severe disease and poor prognosis.
- The specific impact of COPD on long-term mortality in CS-dependent asthma remains unclear.
Purpose of the Study:
- To investigate the effect of coexisting chronic obstructive pulmonary disease (COPD) on long-term mortality in patients with corticosteroid (CS)-dependent asthma.
Main Methods:
- A retrospective cohort study utilized Korean National Health Insurance Service data from 2005-2015.
- Included were patients aged 40+ with CS-dependent asthma, divided into groups with and without COPD.
- Hazard ratios (HR) for all-cause mortality were evaluated, comparing patients with and without COPD.
Main Results:
- The cohort comprised 8,021 patients with CS-dependent asthma; 38.9% also had COPD.
- All-cause mortality was significantly higher in the CS-dependent asthma with COPD group (9,955/100,000 person-years vs. 5,585/100,100 person-years; P < 0.001).
- Adjusted HR for all-cause mortality was 1.29 (95% CI, 1.21-1.38), with increased risks for chronic lower respiratory diseases (SHR, 2.30) and lung cancer (SHR, 1.34).
Conclusions:
- Physician-recognized COPD significantly increases all-cause mortality in CS-dependent asthma patients.
- The risk of death from chronic lower respiratory diseases and lung cancer is elevated in this patient group.
- Prompt identification and effective management of COPD are vital for enhancing treatment outcomes in CS-dependent asthma.
Purpose:
Chronic corticosteroid (CS) use is a risk factor for long-term mortality in asthmatic patients, and the presence of coexisting chronic obstructive pulmonary disease (COPD) is associated with a severe presentation and poor prognosis. However, the impact of coexisting COPD on long-term mortality in patients with CS-dependent asthma has not been well elucidated. This study aimed to determine the impact of coexisting COPD on long-term mortality in patients with CS-dependent asthma.
Methods:
A retrospective cohort of patients with CS-dependent asthma aged 40 years or older was established using records from the Korean National Health Insurance Service database for 2005 to 2015. We classified the subjects into 2 groups according to the presence of COPD and evaluated the hazard ratio (HR) for all-cause mortality in patients with COPD relative to those without COPD.
Results:
Of 8,021 patients with CS-dependent asthma, 3,121 (38.9%) had COPD. All-cause mortality was significantly greater in patients with CS-dependent asthma and COPD than in those without COPD (9,955/100,000 person-years vs. 5,585/100,100 person-years, P < 0.001). The adjusted HRs were 1.29 (95% confidence interval [CI], 1.21-1.38), and the associations were especially significant for chronic lower respiratory diseases (subdistribution HR, 2.30; 95% CI, 2.06-2.57) and lung cancer (subdistribution HR, 1.34; 95% CI, 1.02-1.78).
Conclusions:
In this population-based retrospective cohort study, the presence of physician-recognized COPD was associated with greater all-cause mortality and greater risk of mortality due to chronic lower respiratory diseases and lung cancer in patients with CS-dependent asthma. Early recognition and appropriate management of COPD can improve treatment outcomes in patients with CS-dependent asthma.
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