Inhaled corticosteroid therapy in bronchiectasis is associated with all-cause mortality: A prospective cohort study
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Inhaled corticosteroid therapy in bronchiectasis is associated with all-cause mortality : A prospective cohort study. / Håkansson, Kjell E.J.; Fjaellegaard, Katrine; Browatzki, Andrea; Sin, Melda Dönmez; Ulrik, Charlotte Suppli.
I: International Journal of COPD, Bind 16, 2021, s. 2119-2127.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Inhaled corticosteroid therapy in bronchiectasis is associated with all-cause mortality
T2 - A prospective cohort study
AU - Håkansson, Kjell E.J.
AU - Fjaellegaard, Katrine
AU - Browatzki, Andrea
AU - Sin, Melda Dönmez
AU - Ulrik, Charlotte Suppli
N1 - Publisher Copyright: © 2021 Håkansson et al.
PY - 2021
Y1 - 2021
N2 - Background and Objective: Prescribing inhaled corticosteroids (ICS) for bronchiectasis (BE) in the absence of obstructive lung disease is controversial. Studies investigating ICS therapy and impact on morbidity and mortality in BE are sparse. Methods: This study comprises all patients with BE managed at respiratory outpatient clinics at two university hospitals in the Capital Region of Denmark 2014–2015. Baseline data were obtained from patient medical records, and patients were followed until April 2020. Results: Out of 264 patients, 122 (46%) were prescribed ICS with no demographic differences between users/non-users of ICS. Among patients prescribed ICS, 21% did not have a concomitant diagnosis of asthma or COPD. Patients prescribed ICS had lower lung function (median FEV1 65.2 vs 80.9%pred, p<0.001) and a higher symptom burden in terms of cough (p 0.028), sputum production (p <0.001) and dyspnea (p <0.001). Pseudomonaspositive sputum cultures were more common in ICS-treated patients (6.5 vs 20%, p 0.010), as were previous severe exacerbations (41% vs 21%, p <0.001). In terms of mortality, highdose ICS use was associated with increased mortality in multivariable Cox regression adjusted for age, sex, FEV1 and concomitant asthma/COPD (HR 4.93 [95% CI 1.73–14.0], p 0.003). Conclusion: In this cohort, close to one out of five patients with BE were prescribed ICS despite having no concomitant diagnosis of asthma or COPD. Overall, ICS treatment was associated with higher morbidity and mortality, though causation is difficult to establish.
AB - Background and Objective: Prescribing inhaled corticosteroids (ICS) for bronchiectasis (BE) in the absence of obstructive lung disease is controversial. Studies investigating ICS therapy and impact on morbidity and mortality in BE are sparse. Methods: This study comprises all patients with BE managed at respiratory outpatient clinics at two university hospitals in the Capital Region of Denmark 2014–2015. Baseline data were obtained from patient medical records, and patients were followed until April 2020. Results: Out of 264 patients, 122 (46%) were prescribed ICS with no demographic differences between users/non-users of ICS. Among patients prescribed ICS, 21% did not have a concomitant diagnosis of asthma or COPD. Patients prescribed ICS had lower lung function (median FEV1 65.2 vs 80.9%pred, p<0.001) and a higher symptom burden in terms of cough (p 0.028), sputum production (p <0.001) and dyspnea (p <0.001). Pseudomonaspositive sputum cultures were more common in ICS-treated patients (6.5 vs 20%, p 0.010), as were previous severe exacerbations (41% vs 21%, p <0.001). In terms of mortality, highdose ICS use was associated with increased mortality in multivariable Cox regression adjusted for age, sex, FEV1 and concomitant asthma/COPD (HR 4.93 [95% CI 1.73–14.0], p 0.003). Conclusion: In this cohort, close to one out of five patients with BE were prescribed ICS despite having no concomitant diagnosis of asthma or COPD. Overall, ICS treatment was associated with higher morbidity and mortality, though causation is difficult to establish.
KW - All-cause mortality
KW - Descriptive study
KW - Follow-up cohort
KW - ICS
KW - Non-cystic fibrosis bronchiectasis
U2 - 10.2147/COPD.S311236
DO - 10.2147/COPD.S311236
M3 - Journal article
C2 - 34295156
AN - SCOPUS:85111455455
VL - 16
SP - 2119
EP - 2127
JO - International Journal of COPD
JF - International Journal of COPD
SN - 1178-2005
ER -
ID: 275942671