Inhaled Triple Therapy including corticosteroids Reduces All-Cause Mortality in COPD

China: A new study published in the Chest Journal found that inhaled therapy containing inhaled corticosteroids (ICSs) can reduce the risk of all-cause mortality in patients with Chronic Obstructive Pulmonary Disease (COPD).

Inhaled corticosteroids (ICSs) have been a common maintenance therapy for COPD, but it remains uncertain if their use reduces the all-cause mortality risk and which patient subgroups may benefit. This raises the question of whether inhaled therapy containing ICSs can decrease mortality risk in patients with COPD compared to other therapies.

The study searched multiple databases (PubMed, Cochrane Library, Embase, and ClinicalTrials.gov) for relevant randomized clinical trials (RCTs) and used Peto odds ratios with corresponding 95% confidence intervals to calculate pooled results. The study analysed data from 60 RCTs with over 100,000 COPD patients.

The study concluded with the following clinical findings:

1. 1.Inhaled therapy containing ICSs, especially triple therapy, was associated with a lower all-cause mortality risk.
2. 2.Subgroup analyses revealed that longer treatment duration, medium/low-dose ICSs, and budesonide were involved in this association.
3. 3.The predictors of this association included eosinophil counts of ≥ 200/μL or percentage of ≥ 2%, documented history of ≥ 2 moderate and severe exacerbations in the previous year, Global Initiative for Chronic Obstructive Lung Disease stages III or IV, age younger than 65 years, and BMI of ≥ 25 kg/m2.
4. 4.Eosinophil counts of ≥ 200/μL were found to be the strongest predictor.

The study has certain limitations to be acknowledged, such as the fact that it solely relied on data from randomized clinical trials, which may not accurately represent the actual scenario. Furthermore, the possible adverse effects of ICSs were not considered in the study.

According to the researchers of the study, “The findings of the study could help healthcare professionals make better treatment decisions for COPD patients. The study highlights the importance of considering medication factors and patient characteristics when determining the appropriate treatment for COPD patients.”

Reference:

Chen H., Xu Deng Z., Sun J., et al; Association of Inhaled Corticosteroids With All-Cause Mortality Risk in Patients With COPD- A Meta-analysis of 60 Randomized Controlled Trials; CHEST VOLUME 163, ISSUE 1, P100-114,2023; DOI: https://doi.org/10.1016/j.chest.2022.07.015