Probability and determinants of relapse after discontinuation of inhaled corticosteroids in patients with COPD treated in general practice

Abstract

Objective:

The objective of the study was to assess the probability, and explore determinants of adverse respiratory outcome after discontinuation of inhaled corticosteroid (ICS) treatment in subjects with chronic obstructive pulmonary disease (COPD) diagnosed and treated in general practice.

Design:

Prospective unblinded ICS withdrawal study.

Subjects:

201 ICS treated COPD patients with various degrees of airflow limitation from 45 Dutch general practices.

Main outcome measures:

Probability of and time to exacerbation or unremitting worsening of respiratory symptoms after ICS discontinuation.

Results:

Mean age was 60.6 (S.D. 9.5) years, post-bronchodilator forced expiratory volume in 1s (FEV₁) 65.6 (S.D. 15.7) % predicted. Overall probability of adverse respiratory outcome after ICS discontinuation was 0.37 (95% confidence interval (CI) 0.31, 0.44). Survival analysis showed that age, gender, smoking status and reversibility of airflow limitation were independent predictors of adverse respiratory outcome. For females, the adjusted hazard ratio was 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 lived.

Conclusion:

Discontinuation of inhaled corticosteroids may harm patients with COPD. The probability of an adverse respiratory outcome may be higher in women, elderly patients, smokers and patients with higher bronchodilator reversibility while on inhaled steroid treatment.